Everyday English for International Nurses

A guide to working in the UK

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For Churchill Livingstone:

Commissioning Editor: Ninette Premdas
Development Editor: Kim Benson
Project Manager: Darren Smith
Design: Erik Bigland

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Everyday English for
International Nurses

A guide to working in the UK

EDINBURGH

LONDON

NEW YORK

PHILADELPHIA

SAN FRANCISCO

SYDNEY

TORONTO

2004

Joy Parkinson

Author and Lecturer, London, UK

Chris Brooker

BSc, MSc, RGN, SCM, RNT

Author and Lecturer, Norfolk, UK

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CHURCHILL LIVINGSTONE
An imprint of Elsevier Limited

First published 2004

The right of Joy Parkinson and Chris Brooker to be identified as
authors of this work has been asserted by them in accordance with
the Copyright, Designs and Patents Act 1988.

No part of this publication may be reproduced, stored in a retrieval

system, or transmitted in any form or by any means, electronic,
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ISBN 0 443 07399 6

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A catalogue record for this book is available from the British Library.

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Note
Medical knowledge is constantly changing. As new information
becomes available, changes in treatment, procedures, equipment and
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to confirm that the information, especially with regard to drug usage,
complies with current legislation and standards of practice.

Printed in China

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Preface

This book is designed to help the large numbers of overseas nurs-
es who have chosen to practise in the UK. The content has been
adapted from the Manual of English for the Overseas Doctor, by
Joy Parkinson. The result is a book with a uniquely nursing focus.

It can be a daunting prospect for anyone to move to another

country to nurse; not only must you become familiar with the
organisation and regulation of nursing, but you need to learn how
English is spoken by people in everyday situations. The language
spoken by clients, patients and their families in the UK is vastly
different from that used overseas. Hence a large part of the book
is concerned with the vocabulary and language used in the
nurse–patient relationship.

The first three chapters provide information about nursing in

the UK, the nursing process, professional organisations and trade
unions, registering as a nurse, adaptation programmes and career
development, and the structure of the National Health Service
and Social Services.

Chapter 4 focuses on documentation and record keeping that

are vital to good practice. This chapter also deals with written
communication in the form of letters and e-mail.

Communication in nursing is covered in Chapter 5. This

includes taking a nursing history and many case-history dialogues.
The case histories are based on the Activities of Living Model of
Nursing and provide examples of dialogue between nurses and
patients or relatives in a wide range of situations.

Chapters 6 to 8 deal with the language of spoken English (col-

loquial English, idioms and phrasal verbs). This material is based
on the book for doctors, but it has been completely updated for
the 21st century.

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The last three chapters provide you with more useful informa-

tion – abbreviations used in nursing, useful addresses and web
sources, and units of measurement.

Further reading suggestions and references are included in the

chapters, and a general list of further reading is provided at the
end of the book.

We hope that this new book will be of great help to you during

your nursing career in the UK.

Joy Parkinson and Chris Brooker

London and Norfolk 2004

PREFACE

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Acknowledgements

The authors would like to thank their families and colleagues for
their support and help.

Thanks to Gosia Brykczynska who wrote the first three chapters.
Thanks also to Annie Jennings, RGN, and Andrew Jennings,

MB, FRCS(Urol), for their help in updating the colloquial language,
to Kirsten and Stuart Dallas who offered help with one of the case
histories, and to all the staff at Elsevier who were involved in the
book – in particular, Ninette Premdas and Kim Benson for their
support and enthusiasm throughout the project.

vii

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Contributor

Gosia Brykczynska PhD, RGN/RSCN, RNT, CertEd, Refugee Nurse
Project Officer, Royal College of Nursing, London, UK (Chs 1, 2
and 3).

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Contents

Nursing in the UK

Registering as a nurse in the UK and career
development

The National Health Service and Social Services

Nursing documentation, record keeping and written
communication

Communication in nursing

Colloquial English

123

Idioms: parts of the body

141

Phrasal verbs

169

Abbreviations used in nursing

193

10. Useful addresses and web sources

211

11. Units of measurement

223

General further reading suggestions

231

Index

233

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Nursing in the UK

INTRODUCTION

Today nursing in the UK involves caring for the whole person
(holistic care). This includes emotional, social, psychological,
spiritual and physical factors rather than just a disease or injury.
Nursing care is based on the best evidence available (evidence-
based) and focuses on the individual needs of people using the
healthcare system. Nurses are concerned as much with helping
people to stay well, as with giving care when illness or injury
occurs. Promoting health, giving information and helping people
to learn about managing chronic illnesses is the focus of nursing
in the 21st century. The developments in medical science and
technology, and the breakdown in the traditional barriers
between the healthcare professions have meant that nurses must
now deal with many complex technical aspects of care and treat-
ment. Nursing in the UK is a regulated professional occupation
with a correspondingly thorough education system that meets the
practical and theoretical needs of a modern healthcare system.
Nurse education in the UK is designed to meet changing health-
care needs, the wishes of people needing healthcare, the growth
in complex treatments and the need for a standardised education-
al preparation resulting from membership of the European Union
(EU) (see Ch. 2).

Nurses in the UK base their practice on the systematic assess-

ment, planning, implementation and evaluation of care. In order
to do this they use the nursing process (see below) or integrated
care pathways. This is very different to task-based care, where
nursing activities were strictly allocated according to the nurse’s
seniority. The more complicated tasks, such as giving medicines,
were performed by senior nurses and simple tasks were under-

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taken by the more junior nurses, while the most basic work such
as personal cleansing was carried out by unqualified nursing stu-
dents and nursing assistants or auxiliary nurses.

This chapter will help you to understand how nursing in the

UK is regulated, what nurses do and where they work, and how
they use the nursing process. Details about various professional
organisations and trade unions are also given.

HOW NURSING IS REGULATED IN THE UK

Nursing and midwifery are regulated by the Nursing and
Midwifery Council (NMC). The role of the NMC includes:

— Keeping a register of practitioners (656 000 qualified registered

nurses and midwives in 2003). In 2004 a new three-part regis-
ter – nursing, midwifery and specialist community public
health nursing – replaced a register with 15 parts. The nursing
part of the register has separate sections for first-level and
second-level nurses. The register also notes the particular
branch of nursing – adult, learning disability, children or men-
tal health. The second-level section of the register is for exist-
ing enrolled nurses, but this is closed to new UK applicants.
However, it must be open to existing second-level nurses who
qualified in certain other European countries in order to com-
ply with European Directives. All working nurses need to reg-
ister with the NMC to practise as qualified nurses in the UK.
This registration is renewed every 3 years (see periodic regis-
tration, Ch. 2).

— Setting standards for nursing and midwifery practice.
— Protecting the public and assuring the public that only nurses

and midwives who have reached the minimum standards set
by the NMC can become registered nurses and midwives.

The NMC hears cases of alleged professional misconduct (see

nursing documentation and record keeping, Ch. 4). If the practi-
tioner is found guilty, the NMC can deal with him or her in a vari-
ety of ways, including the removal of the practitioner from the

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professional register, which stops him or her working as a regis-
tered nurse or midwife. In this way, the NMC monitors and reg-
ulates nursing and midwifery and ensures that high standards of
professional practice are maintained.

The NMC has produced a Code of Professional Conduct that

sets out the standards of professional conduct, responsibilities
and accountability expected of a registered nurse or midwife, and
explains a person’s entitlements and reasonable healthcare
expectations about nursing care.

As part of the need to practise safely and effectively as a nurse

and to work within ethical boundaries you need to be familiar
with, to understand and to apply to your practice all parts of the
Code of Professional Conduct. The main clauses of the code are
outlined in Box 1.1, but you should read the full document which
has subclauses that give more explanation.

The Code is sent to every practising nurse in the UK, and any

nurse who does not respect the Code of Professional Conduct
will have to answer for their actions or omissions to the NMC and
others, including the hospital or care home where they work, a
court of law or the Health Service Commissioner. The British pub-
lic demand nursing care that is of a high standard and effective,

NURSING IN THE UK

Box 1.1

The Code of Professional Conduct (NMC, 2002)

The Code of Professional Conduct says that, ‘as a registered nurse or

midwife, you are personally accountable for your practice. In caring for

patients and clients, you must’:

— ‘respect the patient or client as an individual’

— ‘obtain consent before you give any treatment or care’ (see Ch. 4)

— ‘co-operate with others in the team’

— ‘protect confidential information’

— ‘maintain your professional knowledge and competence’

— ‘be trustworthy’

— ‘act to identify and minimise the risk to patients and clients’.

Available online: http://www.nmc-uk.org

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and nurses are constantly trying to raise their standards of care
and to identify areas for improvement. In fact, continuing profes-
sional development (CPD) and a commitment to life-long learn-
ing are both essential if the profession is to keep ahead of the
changes that are occurring and for nurses to feel confident in the
work that they are doing. For more information about CPD, post-
registration education and practice (PREP) and periodic registra-
tion, see Chapter 2.

PROFESSIONAL ORGANISATIONS AND TRADE
UNIONS

The vast majority of practising UK nurses and midwives, and stu-
dents join a professional organisation or trade union. There are
several trade unions to choose from (Box 1.2), but the two most
popular ones with nurses are the Royal College of Nursing (RCN)
and Unison, who have about 600 000 members between them.

A trade union works hard for the welfare and best interests of

its nurse members. Trade unions also provide professional
indemnity insurance for practising nurse members, as do several
private insurance companies. Nurses who are employed are cov-
ered for acts or omissions by their employer’s vicarious liability
arrangements. Professional indemnity insurance against claims for
professional negligence is increasingly important for nurses work-

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

Box 1.2

Trade unions and professional organisations

— The Royal College of Nursing

— Unison

— The Royal College of Midwives (RCM)

— GMB

— Mental Health Nurses' Association

— Community Practitioners' and Health Visitors' Association

— Community and District Nurses' Association.

See Chapter 10 for useful addresses and websites.

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ing in independent or private practice, and the NMC recommends
that these nurses should have adequate insurance.

Many trade unions provide continuing education for nurses

through study days, courses, conferences and nursing journals.
Some organisations, notably the RCN and RCM, provide extensive
libraries. Furthermore, the RCN has one of the largest non-
university affiliated nursing libraries in the world.

The National Nursing Association (NNA) in the UK is the RCN.

It is a member of the International Council of Nurses (ICN), and
is the UK representative on the Standing Committee of Nurses in
Europe.

More information about the services offered by individual

trade unions and professional organisations can be found in an
article by Oxtoby & Crouch (2003) and by contacting the trade
union or professional organisation.

WHERE NURSES WORK – NATIONAL HEALTH SERVICE
AND THE PRIVATE SECTOR

Most nurses and midwives (approximately 400 000) work for the
National Health Service (NHS), 80 000 work in the private sector
within independent hospitals, nursing homes, nursing agencies,
workplaces, prisons, embassies and the armed forces, and 20 000
work for general practitioners (GPs). Others work in education
institutions, in management, as independent practitioners, or as
self-employed consultants.

In the 1980s, new nurse education programmes, called Project

2000 (PK2), were introduced. This moved nurse education into
the higher education sector and nursing students were no longer
considered part of the nursing workforce, as they had been
before, and led to an increased employment of healthcare assis-
tants (HCAs) and auxiliaries. HCAs often give the ‘hands-on’ care,
and increasingly do more complex activities because the role of
nurses has expanded and changed.

Nurses today work not only in hospitals but also in the com-

munity. In fact over a third of all UK nurses work in the commu-

NURSING IN THE UK

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nity – with people in their own homes and in clinics, and in the
workplace as occupational health nurses. Even when nurses are
employed in the acute healthcare sector they not only work on
the wards, but they also work in outpatient departments (OPDs)
often running and co-ordinating clinics on their own, such as in
pre-admission assessment, diabetic care, hypertension clinics,
well-men and well-women clinics, and so on. In addition, UK
nurses are increasingly taking on roles that used to be done by
doctors. This has meant that nurses can now ensure a faster and
more efficient service for people in their care.

Nurses in the UK can choose to work either for the NHS or

for the private healthcare sector. The private sector runs hospi-
tals (general and specialist), and many psychiatric hospitals and
specialist clinics (e.g. infertility clinics and drug detoxification
units). The private sector also provides much of the occupation-
al health services for industry and many private companies, and
run hundreds of nursing homes and other care facilities for older
people and other groups all over the UK. The care of older peo-
ple requires much dedication and is a difficult field of nursing,
but it can be very rewarding and certainly it is an area of nurs-
ing care that will increase in demand as more people live longer,
and proportionally more frail older people will require expert
nursing care.

Although private healthcare establishments are not bound by

NHS pay regulations, they generally pay very similar salaries and
in many instances pay slightly more. There are recruitment
guidelines and UK labour legislation helps to ensure fair and eth-
ical employment practices. Wherever a nurse works in the UK he
or she is protected by employment law and health and safety
regulations which, among other things, specify the maximum
number of hours of work to be undertaken in a specified period
of time, the minimum UK wage, and employment entitlements
and benefits.

Nursing in the UK reflects the challenges and the demands of

UK society as a whole. Nursing is considered a respected and val-
ued profession, and on the whole qualified nurses with several

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years’ clinical experience and working full-time in a UK health-
care establishment, can expect to be adequately financially
rewarded for their expertise and practice. At the time of writing
the government is proposing a new financial package for quali-
fied nurses working in the NHS, which should redress some of
the financial problems and dissatisfactions of the past.

HIGH QUALITY CARE AND THE NURSING PROCESS

Whether you are at the beginning of your career, practising at an
advanced or specialist level, or just newly arrived to work in the
UK from abroad, all nurses must strive to achieve the five Cs of
good nursing practice:

— competent nursing
— commitment to nursing
— confidence in nursing research
— nursing compassion
— informed nursing conscience.

These aspects of caring nursing practice were first expressed by
Simone Roach, a Canadian nurse, in 1984 (Roach 1984). All five
aspects of nursing practice are needed for effective, high-quality
nursing care. It is the caring aspect of nursing work that is most
appreciated by people and their families, and nurses everywhere
are delivering good patient care by demonstrating competency,
commitment, confidence, conscience and compassion in their
work. In many parts of the world, including the UK, these aspects
of nursing care are best shown in nursing practice by using the
nursing process.

The nursing process is a systematic approach to nursing care.

It has four phases (Fig. 1.1):

— assessment
— planning
— implementation
— evaluation.

NURSING IN THE UK

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Although the four phases are described in sequence, in reality
they overlap, and occur and recur throughout the period for
which a person is receiving nursing care.

The nursing assessment refers to assessing a person (patient

or client) for physical, psychological, social or spiritual needs
and deciding on their relative nursing value. The status of the
person is assessed in order to help with planning the nursing
care plan.

The care plan is prepared with a specific person in mind; how-

ever, it is possible to have a prepared standard care plan, which
is then adapted and individualised for a particular person’s needs.
This often happens on day-case surgery units and surgical wards
where routine surgical procedures are undertaken. Such an
approach ensures that not only are routine procedures undertak-
en, but also that the care can be individualised. Care plans may
be hand written or, as is increasingly the case, stored on comput-
ers. In both instances, the information is confidential and should

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

Assessment

Implementation

Planning

Nursing

diagnosis

Evaluation

Fig. 1.1

The nursing process. Reproduced with permission from

Brooker & Nicol (eds), Nursing Adults: the Practice of Caring,
Mosby, 2003.

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be held/stored in a safe place (see Ch. 4). In the UK, patients are
entitled to know their diagnosis, to be included in care planning
and to be consulted at every point of the nursing process cycle.
This is to ensure fully informed and freely given consent to the
care proposed (see Ch. 4).

The implementation of the care plan is based on the initial

assessment process and the care delivered is expected to be
evidence-based (i.e. in accordance with the latest nursing
research findings and medical knowledge). If research findings
are not available the evidence may be developed from the collec-
tion of best expert practice in the field. It is the responsibility of
individual nurses to keep themselves updated in nursing practice,
as they are individually accountable for patient care.

The final stage of the nursing process is the evaluation. At this

point the nurse evaluates the effectiveness of the care delivered
and either decides to continue with the current care plan, con-
siders making changes, or moves on to another new assessment
and care plan, as the person is now at another stage and has dif-
ferent needs. Evaluation must be undertaken against some meas-
urement or established criteria (e.g. a pressure ulcer risk scale).
This stage of the care plan is very important, as otherwise the
nurse runs the risk of continuing to give ineffective and or inap-
propriate care.

The nursing process is used effectively by all nurses in the UK,

regardless of their speciality, and as you gain clinical experience
so it becomes easier to move through the stages of the process.
As you would expect the nursing process needs a caring and
knowledgeable approach and is usually made easier by using an
established model or theory of nursing practice, such as the
Roper, Tierney & Logan (1996) model of nursing based on activ-
ities of living or Orem’s self-care model (1995). The result is that
nursing care is being delivered more appropriately, effectively
and in ways that promote holistic well-being.

Nurses should record all the relevant information at all stages

of the nursing process (see Ch. 4).

NURSING IN THE UK

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AN EXCITING FUTURE – EXPANDING THE ROLE OF
NURSES

In 1999 the UK Government issued a document for nurses to con-
sider: NHS Plan for England (Department of Health 1999) in
which it set out areas that it felt needed to be expanded and to
become more mainstream, so that more nurses could be involved
working in these areas in new and more challenging nursing
roles. The areas were:

— to be capable of and responsible for ordering medical investi-

gations, such as pathology tests and X-rays

— to be capable of making direct referrals to specialist services,

such as a pain control team or the continence adviser

— to have responsibility for both admitting and discharging a

range of patients with specified conditions according to a
protocol

— for more nurses to manage their own patient caseloads, e.g. in

the care of people with diabetes

— to increase the number of nurses who would be educated to

prescribe medicines and treatments

— for nurses to be responsible for resuscitation procedures,

including the use of defibrillation

— to be trained to undertake minor surgery and outpatient

procedures

— to be responsible for the administration of outpatient clinics
— to take lead roles and executive positions in local health ser-

vices and their management.

Nurses now have the chance to expand their practice, such as

prescribing medicines, and diagnosing and treating many minor
injuries and illnesses, as well as continuing to give holistic care,
especially for those people with chronic conditions. Nurses work
in ever more sophisticated and technologically advanced settings
(e.g. in oncology units, endoscopy suites, neonatal units and
renal and dialysis units). This requires a high level of basic nurs-
ing care, continuing post-basic specialist knowledge, a system of

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advanced nursing education to reflect the increased and variable
nursing work environments and an ethical viewpoint that is
informed and sensitive to the needs of people and their families.
The next two chapters will help you to understand the routes and
methods of achieving these specialisations and to have a basic
understanding of the UK healthcare system and the role and func-
tion of nursing within it.

REFERENCES

Department of Health (DoH) 2000 The NHS plan. DoH, London.
Nursing and Midwifery Council (NMC) 2002 Code of professional

conduct. NMC, London.

Orem DE 1995 Nursing: concepts and practice, 5th edn. Mosby,

St. Louis.

Roach S 1984 Caring: the human mode of being, implications

for nursing. Perspective in caring. Monograph 1. Faculty of
Nursing, University of Toronto, Toronto.

Roper N, Logan WW, Tierney AJ 1996 The elements of nursing,

4th edn. Churchill Livingstone, Edinburgh.

FURTHER READING

Brooker C, Nicol M (eds) 2003 Nursing adults: the practice of

caring. Mosby, Edinburgh, Ch. 1.

Oxtoby K, Crouch D 2003 Value for money. Nursing Times

99(17):21–23.

Royal College of Nursing (RCN) 2002 Labour market review.

RCN, London.

NURSING IN THE UK

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Registering as a nurse in
the UK and career
development

INTRODUCTION

Of all the European countries, the UK has the largest number of
overseas trained nurses working within the healthcare system. It
is estimated that there are about 42 000 internationally recruited
nurses practising in the UK, with another 16 000 waiting for place-
ments on supervised practice courses. Every nurse who works in
the UK needs to be registered with the Nursing and Midwifery
Council (NMC). Since 1919 nurses have been regulated in the UK
(Nurse Registration Act) and the NMC is the latest statutory body
set up by Parliament to perform this regulatory role. The NMC
was established in April 2002 and replaced The UK Central
Council for Nursing, Midwifery and Health Visiting (UKCC). The
change in regulatory body coincided with a change in the way
that the nursing profession was to be organised and administered
around the country and was in keeping with major changes
occurring in the delivery of healthcare in the UK (see Ch. 3). One
of the NMC’s main functions is to protect the public by ensuring
that all those who are registered to work as Registered Nurses
(RNs) in the UK are considered to be safe and competent nurs-
ing practitioners (see Ch. 1).

This chapter will help you to understand how to obtain initial

registration with the NMC and the requirements for periodic reg-
istration. There is further information about adaptation courses,
and in addition the chapter will help you to develop your career
and be successful as a nurse in the UK.

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NURSING PROGRAMMES AND OBTAINING
REGISTRATION

The first thing an overseas trained nurse must do to get onto the
NMC register is to write to the NMC (for the address see Ch. 10)
for an application pack. The pack gives information about pay-
ments and how to fill out the forms and what is needed to
become a nurse in the UK. Information on how to apply to the
NMC for registration can also be obtained from the NMC website
(http://www.nmc-uk.org). The first sum of money you send off
to the NMC is to cover the administration cost of processing the
application forms. Refugee nurses do not have to pay the initial
fee if they send the NMC a copy of the letter from the Home
Office confirming their refugee status.

It is the NMC who will determine whether you are a safe and

competent practitioner to work in the UK. This is done by look-
ing at all applications on an individual basis. The NMC will assess
several different things about you; for example, your nursing edu-
cation, character references (from your school of nursing and
employers), and experience and career pathway.

Nursing education models vary considerably around the world

and Registered Nurses may undertake courses that last anything
from 1 to 4 years. Some nurses have been educated at universi-
ties and colleges of higher education, others on pre-matriculation
courses (before leaving secondary school) and also in specialised
nursing further education institutes, which are often attached to
specific teaching hospitals.

In some countries nursing programmes follow a universal

healthcare career structure, where all or many of the healthcare
workers progress together through a generic health worker train-
ing programme. However, some individuals remain at particular
levels, while others will continue their education to gain more
experience and thereby change the role that they are qualified to
undertake. In other countries nurse education is completely sep-
arate from other healthcare professions. In the UK all nurse edu-
cation, wherever it is provided, follows the European Union (EU)
Directives on the nature and length of nurse education
programmes.

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The majority of overseas trained nurses will be seeking to have

their name put on the nursing part of the register (for more infor-
mation on the three-part register, see Ch. 1) and most of these
will be for adult nursing. To be placed on the register you need
to demonstrate that your nursing education programme meets the
conditions outlined in Box 2.1.

These rules and regulations were agreed by the EU and have

been agreed as valid for the whole of Europe. This was agreed in

REGISTERING AS A NURSE IN THE UK AND CAREER DEVELOPMENT

Box 2.1

Nurse education programmes – conditions required

for UK registration

— Duration of at least 3 years of full-time nursing studies and which

included at least 4600 hours of nursing education.This means that

unrelated subjects, such as foreign languages, sport or philosophy, do

not count towards the nursing education hours, but applied subjects

such as healthcare ethics would be relevant.

— The nursing programme does not have to be delivered at a degree

level, but it should be undertaken after completion of full secondary

education and after reaching the age of 17.

— The nursing programme needs to be equally divided between theory

and practice and the programme must cover five main areas, i.e. med-

ical, surgical, women and children, mental health and community.

— Upon completion of the nursing education programme, nursing stu-

dents should be considered to be fully qualified registerable first-level

nurses and fully capable of obtaining the nursing diploma and right to

practise.This implies that the nursing education programme is consid-

ered to be complete in itself and without additional practice periods

and/or supervision, and that until nursing students obtain the nursing

diploma they are not considered to be fully qualified first-level nurses.

Apart from these requirements, the NMC requests that nurses complete

at least 6 months of nursing work in their home country to consolidate

their educational experience. Nurses trying to obtain UK registration

without 6 months' experience in their home country might experience

problems getting onto the register.

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an effort to standardise the level of nurse education in Europe,
and thereby enable automatic recognition of qualifications
between the countries of the EU. Thus, if a qualified nurse from,
for example, Zambia obtains nursing recognition from the NMC
as a fully qualified first-level nurse in the UK, and obtains an NMC
Professional Identification Number (PIN) and is put on the UK
nursing register, the UK registration and recognition is valid
throughout the whole of Europe. It means that Registered Nurses
can easily move around within the EU for purposes of continuing
nurse training and obtaining professional work.

The same rules ensure that the levels of nurse education are

automatically raised overall. With the introduction of this type of
nurse education the countries of Europe were asked to close their
second-level nursing programmes. The only way to become a
nurse in the EU today is by undertaking a 3-year programme of
full-time education at post-secondary school level, as already
described. The only nurses in Europe who are practising on the
second-level register are those nurses who completed their train-
ing before the new regulations came into force, either from the
UK or from other EU countries.

Will your application be accepted?

The NMC may accept your qualifications, require you to do an
adaptation course, or insist on further training:

1. The NMC may fully recognise your qualifications, and because

the education programme was conducted in English and it
covered the European nursing education requirements you
can be admitted onto the register without any additional
requirements. This is the common situation if you have com-
pleted university degrees in nursing from North America,
Australia or New Zealand and have sufficient additional prac-
tical nursing experience.

2. The vast majority of all other nurses will receive a letter from

the NMC stating that their qualifications are sufficient for them
to be put on the NMC register but that now they must com-

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plete an adaptation programme (supervised practice) in an
approved healthcare establishment in the UK over a specified
period of time. This can range from 3 months to 1 year, but
most commonly is for a period between 3 and 6 months.

3. Some non-EU trained nurses will be asked to undertake more

pre-registration nurse education before they can be put on the
UK register. Meanwhile, some of their original nurse training
can be considered valid and academic credits can be awarded
towards the new UK pre-registration nursing education. This
process of giving credit for prior education is called
Accreditation of Prior Experience and Learning (APEL). Every
school of nursing in the UK can undertake this accreditation
process for overseas-trained nurses. APEL was put into place
to help adult mature entrants return to formal education to
obtain new skills, and now this process is being extended to
include previous achievements, even those gained overseas. It
is a long process, but well worth undertaking.

The NMC may ask you for more information before they make

a decision, or reject your application if your nursing course was
less than 3 years long or you cannot meet other requirements (see
Box 2.1).

Once you have completed all the requirements set by the NMC

and sent your initial registration payment to the NMC, you will
receive a PIN and a copy of the NMC Code of Professional
Conduct (see Ch. 1).

Adaptation programmes (supervised practice)

Unfortunately there are not enough places on adaptation pro-
grammes. Although almost all acute NHS Trusts and many
Primary Care Trusts (PCTs) do provide adaptation programmes,
there are still not enough to provide adaptation placements for
the large numbers of overseas trained nurses wishing to work in
the UK.

Adaptation programmes for overseas trained nurses are run

jointly by the NHS Trusts who provide access to the clinical areas

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and the necessary mentors and schools of nursing, who provide
the lecturers and teaching support. Some approved supervised
placements can also be undertaken in the independent sector,
predominantly in care homes for older people. There is a short-
age of placements for supervised practice because there are not
enough qualified nurses to undertake the training necessary to
become mentors, and the clinical areas are already completely
full of pre- and post-registration nursing students. The authorities
who commission and fund adaptation programmes are trying to
increase the number of placements. The NMC is also beginning
to look at other ways of assessing nurses’ readiness to practise in
the UK, such as by passing an examination, which may or may
not include a clinical component, but all these alternatives are still
a long way away.

It is because of these logistical problems that the NMC recom-

mends that overseas trained nurses do not arrive in the UK until
they have a guaranteed place on an approved adaptation course,
since at the time of writing there is an estimated 2- to 3-year back-
log in getting onto an adaptation programme in the UK.

Communication in English – International English Language
Testing System

Overseas trained nurses need to be able to demonstrate the use
of the English language to a level that is good enough to commu-
nicate with colleagues and patients and to function safely in the
clinical environment. The NMC currently requires that all overseas
trained nurses who completed their training in a language other
than English need to pass the International English Language
Testing System (IELTS) examination. The IELTS is a specific
English language test that is administered by the British Council
in centres worldwide. The IELTS test required for nurses is the
General Test, and this consists of several sections, such as com-
prehension and communication. All these sections need to be
completed successfully with a minimum grade of 5.5; however,
an overall grade of 6.5 must finally be achieved. Many nurses find

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the examination difficult and not necessarily appropriate for nurs-
ing practice. The NMC is considering several other possibilities,
but one thing is sure – nurses whose first language is not English
will need to demonstrate that they have a reasonable command
of the English language. In addition to needing sufficient English
to function safely in clinical areas and with patients, overseas
trained nurses will need the equivalent of IELTS grade 6.5 in
order to undertake further nursing education at a UK university.

PERIODIC REGISTRATION AND CONTINUING
PROFESSIONAL DEVELOPMENT

Periodic registration

The nursing register is constantly being updated, and you will
need to update your right to be on the register by periodic regis-
tration. The right to practise as a nurse in the UK is not only
dependent on paying an initial fee, but you must also complete
a Notification of Practice form every 3 years and pay another fee,
and fulfil certain requirements for post-registration education and
practice (PREP) (Box 2.2).

Continuing professional development

Continuing professional development (CPD) can be gained in a
number of ways, for example:

— Reading professional articles in the nursing press, such as the

Professional Nurse, Nursing Times or Nursing Standard. Doing
literature searches relevant to your area of practice.

— Visiting other units.
— Ward teaching sessions, study days, conferences or seminars.
— Short courses, such as moving and handling, managing aggres-

sion and pain control. Longer courses, such as a degree, or
studies that lead to registration on another part of the NMC
nursing register, or the community public health nursing or
midwifery parts of the register.

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The important thing is that you are able to demonstrate an
approach to professional nursing that is consistent with the prin-
ciples of life-long learning. The way to do this is to keep a per-
sonal professional profile/portfolio that contains evidence of all
the CPD activities you have achieved over a 3-year period. This
is a requirement for PREP, and if you keep your profile up to date
you will always be ready for periodic registration.

It is vital to reflect on your CPD activities, so you can identify

what you have learned and its relevance to your practice.
Reflection is an important part of all nursing activity, which of
course ties into the evaluation stage of the nursing process (see
Ch. 1). Many overseas trained nurses will already have been
asked to undertake a reflective diary on their adaptation course,
so you will probably be familiar with this approach. Reflecting on
personal nursing practice is crucial to meaningful CPD.

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

Box 2.2

Post-registration education and practice (PREP)

The requirements for periodic registration are:

— undertake a minimum of 5 days or 35 hours of learning that is rele-

vant to their practice (see Continuing Professional Development

(CPD), p. 19)

— work in some capacity by virtue of their nursing qualifications for a

minimum of 750 hours (100 days) during the last 5 years, or have

done a return to practice course

— keep a personal professional profile of their learning (see Further

Reading and Resources at the end of this chapter)

— comply with any request by the NMC to check (audit) how the

requirements have been met.

The NMC states that the CPD requirements for PREP can be achieved in

many different ways and need not cost a lot of money (see Further

Reading and Resources at the end of this chapter).

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DEVELOPING YOUR CAREER

Some adaptation placements, nursing courses and all job vacan-
cies are published in the nursing press and sometimes in local
newspapers. It may also be a good idea to go to the local hospi-
tal or PCT headquarters and look at the job vacancies bulletin
board. The NMC also provides a website of job vacancies
(http://www.nmc4jobs.com). Whether you are applying for an
adaptation placement or for a first nursing job after completing
the supervised practice, you will need to complete a curriculum
vitae (CV) (see Further Reading and Resources at the end of this
chapter), to fill out an application form, and if short-listed you
will need to attend an interview. It is really important that the
application form is filled out correctly and that your CV is com-
plete, so that the reader (i.e. the prospective employer) knows
who you are, what you have done and why you want the job. If
you do not provide all the information you are unlikely to get
short-listed for an interview.

Many teachers of English as a Second Language (ESOL) and

IELTS classes will help you write a CV and explain how to fill out
application forms. In addition, you can ask for help from Job
Centres or your nursing mentors, whoever is more accessible and
appropriate. There are also many books about how to complete
application forms and a CV, and how to prepare for interviews.
These can be found in public and nursing libraries.

Preparing for a job interview is time well spent – you should,

for example, be familiar with the job description and any special
responsibilities of the post (see Further Reading and Resources at
the end of this chapter). If you are unable to attend on the date
given for an interview it is considered polite to inform the per-
sonnel department; as they were impressed enough to invite you
for interview they may well offer you another date. It is essential
to give yourself plenty of time to get to the interview, to be punc-
tual, to be prepared and to be positive about the experience,
however nervous you may be. If you find you are going to be late
for a reason beyond your control, it is a good idea if at all possi-

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ble to telephone and explain the situation. That way, they may
even offer you another time to attend the interview.

At the start of your UK nursing career (whether in the National

Health Service (NHS) or the private sector) you will be placed on
a fairly basic salary grade, most probably grade D or E (see Ch.
3). When you are ready for more responsibility and can work in
more specialised areas you will be given the opportunity to apply
for more senior posts and develop your nursing career. The NHS
pay and career structure is undergoing change, and a new system
of payment and assessing workloads and work definitions is
being piloted and will then be introduced nationwide (Agenda
for Change, Department of Health 1999).

Most employers require nurse managers, including ward sisters

and charge nurses to have at least a first degree in nursing or a
relevant subject and usually evidence of specialisation in the
work undertaken in the clinical area. Nursing degrees (first and
higher degrees) are offered by schools of nursing which are
based in universities. A degree can last from between 1 and
3 years, depending on the existing level of nursing education.
There are many opportunities for advancing your nursing career
through education, and many of these are sponsored by the NHS.

It is common nowadays for your manager to do periodic

reviews of your work with you. When you have a review meet-
ing it is important to talk about your career plans and to start
mapping out (planning and deciding) how you plan to achieve
your nursing goals. Moving around clinical areas is one way of
gaining new experience, but most UK nurses progress slowly
through a given specialty, becoming more expert in specific
aspects of nursing care (e.g. pain control, stoma care, tissue via-
bility or substance misuse).

REFERENCES

Department of Health (DoH) 1999 Agenda for change. DoH,

London.

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FURTHER READING AND RESOURCES

Banks C 2003 How to ... excel at interview. Nursing Times

99(33):58–59.

Hyde J 2002 In: Brooker C (ed). Churchill Livingstone’s

dictionary of nursing, 18th edn. Churchill Livingstone,
Edinburgh, p 512–518.

Hoban V 2003 How to ... write a CV. Nursing Times

99(27):52–53.

Registering as a nurse or midwife in the UK, see the NMC

website: http://www.nmc-uk.org

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The National Health
Service and Social
Services

INTRODUCTION

Since 1948 the healthcare system in the UK has been structured
around the National Health Service (NHS) and social welfare has
been delivered by local Social Service agencies. Both systems are
maintained from the contributions of UK taxpayers, but the servi-
ces are available to everyone, whether they pay taxes or not, such
as children and some older people.

Although the NHS and Social Services have changed dramati-

cally over the years, most people in the UK still want a national
healthcare and social welfare system to continue to serve the
whole population. Currently, the NHS is undergoing further struc-
tural change, which is aimed at improving the services to the pub-
lic and making NHS workers more accountable to patients and
UK taxpayers.

There are over a million people working for the NHS, as

healthcare professionals and individuals supporting the clinical
staff, such as electricians, gardeners, managers and clerical staff.
The public sector NHS provides over 75% of the healthcare deliv-
ered in the UK.

This chapter will help you understand how the NHS is organ-

ised in England (services in Wales may be different and in
Scotland services are organised differently) and explain the vari-
ous roles of people within the NHS and the close links between
the NHS and Social Services.

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THE STRUCTURE OF THE NHS

The NHS is the responsibility of the Department of Health (DoH)
with a remit to deliver comprehensive healthcare to the public.
This ranges from primary care, including access to general prac-
titioners (GPs), screening programmes, maternity care, mental
health, secondary (surgical and medical) care in hospitals, spe-
cialist hospitals, and through to care of chronically ill people and
those needing palliative care.

New developments in medical science place extra demands on

the NHS and means that treatment provision needs to keep
changing, as do the medicines that doctors and nurses can pre-
scribe. It is one of the aims of the DoH to ensure that all treat-
ments delivered by the NHS are evaluated and evidence based.
The National Institute for Clinical Excellence (NICE) is the gov-
ernment agency set up to evaluate new treatments and drugs and
provide guidance (see Further Reading and Resources at the end
of this chapter). This is to guarantee that the best care is deliv-
ered by the most cost-effective method.

In the last few years the DoH has launched NHS Direct, an

innovative service with a completely new approach to healthcare.
NHS Direct is a telephone helpline (0845 4647), which aims to
empower individuals and prevent the inappropriate use of GPs
and emergency departments for minor conditions, by providing
information and healthcare advice. NHS Direct is operated
24 hours a day by qualified nurses and health workers. The oper-
ators recommend what the caller should do (e.g. call an emer-
gency ambulance, make an appointment to see their GP, or take
a simple self-care remedy). The service empowers people to take
responsibility for their health and the choices that they make. NHS
Direct also provides web-based information about healthcare and
the NHS (www.nhsdirect.nhs.uk).

The DoH manages the overall health and social care system,

develops policy and manages changes in the NHS, regulates and
inspects health and social care establishments and services and
intervenes when necessary to improve services.

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The work of the DoH is divided into two main areas:

— Strategic Health Authorities (SHAs), based on specific geo-

graphical regions. The SHAs ensure that NHS Trusts deliver the
healthcare that has been commissioned, and they oversee var-
ious aspects of workforce planning (e.g. monitoring and
arranging the training of healthcare workers, including nurs-
es). They work with NHS Trusts and universities to plan and
support clinical placements for overseas trained nurses (see
Ch. 2). The SHA is responsible for strategic healthcare plan-
ning and for ensuring that national priorities are integrated
into the work of the Primary Care Trusts (PCTs) and NHS
Trusts (see below). Thus the SHA is concerned with primary
healthcare and community services, which are organised by
the PCTs, and acute hospital (secondary) services provided by
NHS Trusts. Mental healthcare (delivered by mental health
nurses) may be delivered either through the services of a spe-
cial Psychiatric NHS Trust (covering inpatient and outpa-
tient/community services) or by a Community NHS Trust (i.e.
a PCT) or a General NHS Hospital Trust.

— Special health authorities, called Special Trusts. Special Trusts

are usually considered to be secondary care providers or
sometimes tertiary referral centres, such as the Hospital for
Sick Children in London. Other Special Trusts include some
inpatient units designated for forensic psychiatry.

Primary Care Trusts

PCTs work closely with Social Services (see below) and other
agencies and organisations to assess local health needs, plan,
develop and deliver community and primary healthcare services,
and commission secondary services for the local population, in
order to improve health and reduce inequalities in health. PCTs
are responsible for public health and various intermediate care
services. The SHA is responsible for the performance manage-
ment of PCTs. Over recent years there has been a huge shift in
how and where healthcare is delivered and much more care is

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provided within the community (person’s home, care homes,
NHS walk-in centres, healthcare clinics, etc.) by Primary
Healthcare Teams (PHCTs) comprising nurses, midwives, doctors,
therapists, etc. In addition, pharmacists, dentists, opticians and
optometrists, and podiatrists all work within the community.

Primary Healthcare Team
GPs usually work in a group practice with several doctors who
work within a team comprising practice nurses, district nurses
(DNs), health visitors (HV), community midwives, community
mental health nurses, physiotherapists, occupational therapists,
speech and language therapists, counsellors and podiatrists, etc.
Other professionals involved include school nurses (school health
advisers), dieticians, etc. The PHCT delivers basic medical servic-
es, community care and liaises with local acute NHS Trusts for the
continued and ongoing care of their patients. Practice nurses and
GPs are usually the first point of contact for the person who is
unwell or needs healthcare advice.

The nursing and midwifery roles within the team include:

— The practice nurse is a Registered Nurse (adult) who works

alongside the GP in the GP surgery and often runs specialised
clinics (e.g. immunisation, family planning and diabetic clin-
ics). Some practice nurses are also nurse practitioners who
perform many activities that are considered to be an extension
of traditional nursing roles. Nurse practitioners are educated
(usually to degree level) to diagnose and manage many basic
conditions and to prescribe medications from the Nurse
Prescribers’ Formulary (NPF). Suitably qualified district nurses
and health visitors also prescribe from the NPF.

— District nurses (DNs), who are also called community nurses,

are responsible for the nursing care provided for people in
their homes or in care homes. DNs are Registered Nurses (usu-
ally adult branch, although some are paediatric or learning dis-
ability nurses) who have undertaken additional education at a
university to obtain a degree in community nursing. A DN
usually supervises a small nursing team of staff nurses and

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nursing assistants. Various health and social care professionals
may ask for a DN to assess a person in their home or a patient
may make a self-referral; similarly, a hospital may request that
a DN provide nursing care for a person following discharge
from hospital.

— Health visitors (HV) are Registered Nurses who have under-

gone further university nursing education in order to work in
the community and who specialise in health promotion, health
education and health maintenance. HVs do not deliver hands-
on nursing care. They concentrate on the welfare of small chil-
dren and mothers, but some HVs also work with older people
or groups with specific needs, such as refugees. In every geo-
graphical area there will be a designated HV who is responsi-
ble for children with special needs and those children who
may be at risk of being neglected or abused physically, men-
tally or sexually by their parents or carers.

— Community midwives provide professional care during preg-

nancy and labour and look after newly delivered mothers and
their babies in the community. Most babies are born in a
District General Hospital in the UK and in many areas com-
munity midwives accompany women into hospital to conduct
the delivery and take the woman and new baby home after a
few hours if all is well. Community midwives attend home
births, especially for women who have already had a child and
are expected to have a straightforward delivery. They also pro-
vide care for women who have been discharged following a
booked hospital delivery. In an uncomplicated delivery the
woman and baby are often discharged home to the care of the
community midwife within 12 hours.

— Community mental health nurses also work in the community,

but they specialise in the care of people with mental health
problems. They work with people in their own homes,
community-based mental health units, drugs and alcohol servi-
ces and the criminal justice system. They liaise with other
members of the PHCT, psychiatrists from local NHS Mental
Health Trusts, clinical psychologists and social workers.

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Other community health professionals
See Box 3.1 for an outline.

Ambulance Trusts

The Ambulance Service provides emergency care in the event of
serious illness or accident. Ambulance paramedics will stabilise
the person’s condition and then transport them to the most
appropriate emergency department (e.g. the local District
General Hospital). There is no charge for an emergency ambu-
lance, which is summoned by telephoning (999). You must ask
the operator for an ambulance, explaining as clearly as possible
the nature of the problem and the location. The Ambulance
Service itself is divided into emergency services and patient trans-
port services.

Secondary Care – NHS Acute Care Trusts

Secondary hospital care in the UK is delivered by NHS Trusts.
Acute care hospitals and some inpatient continuing care units
(e.g. for the care of older people) are part of NHS Trusts.
Hospitals are managed by a chief executive who is accountable
to the Executive Board of the Hospital Trust. Increasingly, the
management of hospitals is delegated to specific clinical direc-
torates within the Trust. Secondary care is provided in outpatient
departments, day case units and inpatient beds.

Nursing staff
Many nurses wear a uniform of some sort, which varies from hos-
pital to hospital and even within a hospital according to rank but
also according to nursing department. For example, paediatric
nurses often wear colourful tops and tabards, while those in
intensive care wear theatre tops and trousers, and mental health
nurses and senior nurses may wear their own clothes.

Within each Hospital Trust there will be a chief nurse (who

may be known as the nursing director, etc), who also sits on the

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Trust board. The chief nurse provides professional nursing lead-
ership and is responsible for the overall implementation of nurs-
ing policies in a Trust and for the smooth running of the nursing
department.

THE NATIONAL HEALTH SERVICE AND SOCIAL SERVICES

Box 3.1

Other health professionals working in the community

— Community pharmacists: most work within the NHS although they

are independent practitioners. A typical pharmacist on the high

street will have a working relationship with their local GP surgeries.

Medicines and surgical/nursing supplies written out on a GP's or

nurse's prescription form will be dispensed by the pharmacist. A

standard NHS prescription charge applies to each item, but most

people are exempt and do not pay for prescriptions.These include

children and pregnant women, people aged over 60 years, people

receiving certain social security benefits and people with certain

conditions (e.g. diabetes mellitus). Community pharmacists also

offer advice to the public about minor ailments and all aspects of

medication.

— Dentists are independent practitioners and some work with NHS

patients and provide services to patients at NHS rates. However,

there are few dentists who provide care under the NHS and currently

PCTs are employing more dentists to deliver NHS dental care.There

are several NHS dental hospitals in the UK, which provide for patients

with maxillofacial and dental problems.These hospitals also train and

provide practical placements for specialist personnel such as dental

nurses and speech and language therapists and of course dentists and

postgraduate dental surgeons.

— Opticians are also independent practitioners, but most work with NHS

patients and provide services to people at NHS rates. Some

optometrists and opticians work in NHS hospitals, but the majority

practise in the community. Certain groups of people do not pay for

eye care; these include pregnant women and children. People aged

over 60 years and those with conditions such as diabetes or glaucoma

are exempt from some charges.

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Currently the nursing posts open to qualified Registered

Nurses are graded from D to I:

— A D grade staff nurse is considered the first nursing post that

a newly qualified nurse undertakes. A D grade post is really a
‘consolidation’ post, where the new nurse graduate consoli-
dates the training and education that he or she has received
before seeking promotion after a year or two. Initially, most
overseas trained nurses will be D grade until they become
used to nursing in the UK. However, depending on a nurse’s
previous experience and learning, he or she may be upgraded
very quickly.

— An E grade is for a more experienced staff nurse.
— A staff nurse is responsible to the F or G grade nurse known

as the ward sister/charge nurse (male) or ward manager.
Some hospitals use F grade for senior staff nurses, whereas
others use it for junior ward sisters/charge nurses. Apart from
staff nurses, ward sisters/charge nurses, healthcare assistants
and nursing students there will be senior nurses, clinical nurse
specialists, research nurses, lecturer–practitioners and nurse
consultants who are also employed by some PCTs.

— Senior nurses (G, H or I grade) usually have a managerial role

as well as responsibilities for a clinical speciality. Some senior
nurses have responsibility for several wards or units and they
are responsible to a general manager for organisational issues
and to the chief nurse for professional issues. Some senior
nurses have taken on the role of the modern ‘matron’, a post
that is intended to give mid-level nursing managers more
authority over hospital matters, and especially control over
issues such as the cleanliness of the hospital. There are many
clinical nurse specialists working in hospitals (and the com-
munity), especially in specialised areas such as pain control,
palliative care, stoma care and oncology. The nurse will have
undergone further education at a university and be a role
model for colleagues, acting as mentor and educationalist. The

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lecturer–practitioner has a commitment to a student group at a
university, teaches and undertakes nursing research, in addi-
tion to the role of specialist nurse.

There is quite a difference between the pay of the D grade

nurse who is starting a career in nursing and a G or H grade
nurse. However, this pay arrangement is in the process of change,
as the government is piloting a new system of payment and
assessing workloads and work definition (Department of Health
1999) prior to its introduction nationwide. The new pay deal will
be beneficial to junior nurses, but to progress in the nursing
career structure it is necessary to undertake further training and
education (see Ch. 2).

Medical staff
Medical staff posts in hospitals are structured, with the post of
consultant (e.g. a nephrologist) being at the top of the clinical
speciality:

— Consultant: a physician or surgeon who has completed a

lengthy postgraduate specialisation.

— Associate specialist: an experienced doctor who is nominally

under the supervision of the consultant.

— Staff grade: a doctor who provides support for consultants.
— Specialist registrar: a doctor undertaking higher specialist

training.

— Senior house officer: a doctor undertaking basic specialist

training.

— House officer (pre-registration): a newly qualified doctor in the

year following qualification.

Surgeons in the UK are addressed as Mr or Mrs/Miss/Ms.

The introduction of European Union Working Directives has

reduced junior doctors’ hours and this has meant that some nurs-
es are trained to undertake some of the work traditionally done
by junior doctors.

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Professions allied to medicine and other staff
There are many other groups of professionals working in hospi-
tals (e.g. radiographers, technicians, medical scientists, physio-
therapists, speech and language therapists, play therapists, teach-
ers (in children’s hospitals) and social workers). You will also
encounter translators and healthcare advocates, who are bilingual
native speakers of various languages.

SOCIAL SERVICES

Social Services are provided by Local Authorities (local govern-
ment). For example, Norfolk County Council provides services for
the people who live in the county of Norfolk. Social Service
departments have a statutory responsibility to provide care for
groups that include:

— children and young people
— people with disabilities, including sensory impairments
— people who have problems with alcohol and drugs
— older people
— people with mental health problems.

Care and support is provided in the person’s own home or in

small community-based care units. People needing these services
will have a named social worker to co-ordinate and monitor the
care package. The care package may include help with personal
care, day centres, respite care and home modifications such as
bath rails and stair lifts.

As you advance in your UK nursing career you will have a

great deal of contact with social workers. Joint working between
health and social care professionals is vital for effective care plan-
ning and delivery. This is especially so in discharge planning, and
in the community where there is considerable overlap between
the work of health and social care professionals. In many areas,
such as mental health and children, health and Social Services
have formed a single Social Services & NHS Trust which aims to
provide high-quality care.

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REFERENCES

Department of Health (DoH) 1999 Agenda for change. DoH,

London.

FURTHER READING AND RESOURCES

Clinical guidance, see the National Institute for Clinical

Excellence (NICE) website: www.nice.org.uk

Medicines and healthcare products, see the Medicines and

Healthcare products Regulatory Agency (MHRA) website:
www.mhra.gov.uk

Public health (infection control, poisons, chemical and radiation

hazards), see the Health Protection Agency (HPA) website:
www.hpa.org.uk

THE NATIONAL HEALTH SERVICE AND SOCIAL SERVICES

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Nursing documentation,
record keeping and
written communication

INTRODUCTION

Accurate record keeping and careful documentation is an essen-
tial part of nursing practice. The Nursing and Midwifery Council
(NMC 2002) state that ‘good record keeping helps to protect the
welfare of patients and clients’ – which of course is a fundamental
aim for nurses everywhere. You can look at the full Guidelines
for records and record keeping by visiting the NMC website
(www.nmc-uk.org).

It is equally important that you can also communicate by letter

and e-mail with other health and social care professionals, to
ensure that they understand exactly what you mean.

NURSING DOCUMENTATION AND RECORD KEEPING

High quality record keeping will help you give skilled and safe
care wherever you are working. Registered Nurses have a legal
and professional duty of care (see Code of Professional Conduct,
Ch. 1). According to the Nursing and Midwifery Council guide-
lines (NMC 2002) your record keeping and documentation should
demonstrate:

— a full description of your assessment and the care planned and

given

— relevant information about your patient or client at any given

time and what you did in response to their needs

— that you have understood and fulfilled your duty of care, that

you have taken all reasonable steps to care for the patient or

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client and that any of your actions or things you failed to do
have not compromised their safety in any way

— ‘a record of any arrangement you have made for the continu-

ing care of a patient or client’.

Investigations into complaints about care will look at and use

the patient/client documents and records as evidence, so high
quality record keeping is essential. The hospital or care home, the
NMC, a court of law or the Health Service Commissioner may
investigate the complaint, so it makes sense to get the records
right. A court of law will tend to assume that if care has not been
recorded then it has not been given.

Documentation

You will see lots of different charts, forms and documentation.
Every hospital, care home and community nursing service will
have the same basic ones, but with small variations that work best
locally. The common documents that you will use include some
of the following.

Nursing assessment sheet
The nursing assessment sheet contains the patient’s biographical
details (e.g. name and age), the reason for admission, the nursing
needs and problems identified for the care plan, medication,
allergies and medical history.

Nursing care plan
The documents of the care plan will have space for:

— Patient/client needs and problems.
— Sometimes, nursing diagnoses will be documented but these

are not used as frequently as in North America.

— Planning to set care priorities and goals. Goal-setting should

follow the SMART system, i.e. the goal will be specific, meas-
urable, achievable and realistic, and time-oriented. For exam-

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ple, a SMART goal would be that ‘Mr Lee will be able to drink
1.5 L of fluid by 22.00 hours’. Some goals, such as reducing
anxiety, are not easily measured and it is usual to ask patients
to describe how they feel about a problem that was causing
anxiety.

— The care/nursing interventions needed to achieve the goals.
— An evaluation of progress and the review date. This might

include evaluation notes, continuation sheets and discharge
plans. In some care areas you might record progress using a
Kardex system along with the care plan.

— Reassessing patient/client needs and changing the care plan as

needed.

Vital signs
The basic chart is used to record temperature, pulse, respiration
and possibly blood pressure. Sometimes the patient’s blood pres-
sure is recorded on a separate chart. Basic charts may also have
space to record urinalysis, weight, bowel action and the 24-hour
totals for fluid intake and output. More complex charts, such as
neurological observation charts, are used for recording vital signs
plus other specific observations, which include the Glasgow
Coma Scale score for level of consciousness, pupil size and reac-
tion to light, and limb movement (Fig. 4.1).

Fluid balance chart
This is often called a ‘fluid intake and output chart’ or sometimes
just ‘fluid chart’. It is used to record all fluid intake and fluid out-
put over a 24-hour period. The amounts may be totalled and the
balance calculated at 24.00 hours (midnight), or at 06.00 or
08.00 hours. Sometimes the amounts are totalled twice in every
24 hours (i.e. every 12 hours). Fluid intake includes oral, naso-
gastric, via a gastrostomy feeding tube, and infusions given intra-
venously, subcutaneously and rectally. Fluid output from urine,
vomit, aspirate from a nasogastric tube, diarrhoea, fluid from a
stoma or wound drain are all recorded (Fig. 4.2).

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ARKINSON

AND

BR
OOKER:

EVER

Y
ENGLISH FOR INTERNA

TIONAL NURSES

Eyes open

Best verbal

response

Best motor

response

Spontaneously

To speech

To pain

None
Orientated
Confused

Inappropriate

words

Incomprehensible

sounds

None
Obey commands

Localise pain

Flexion to pain

Extension pain

None

Blood

pressure

and pulse

rate

240

230

220

210

200

190

180

170

160

150

Temperature

°C

Usually record

the best arm

response

Endotracheal

tube or

tracheostomy

= T

Eyes closed

by swelling

= C

NAME:
HOSP. No.:
AGE:

DATE:

TIME:

CONSULTANT:

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NURSING DOCUMENT

TION,

RECORD KEEPING

AND

WRITTEN COMMUNICA

TION

Pupils

" #

$% #&

' #&

(

)(

*
–

, - %

# %

" #

$% #&

' #&

)(

Arms

Legs

Fig. 4.1

Neurological observation chart: the Glasgow Coma Scale. Reproduced with permission from Brooker &

Nicol (eds), Nursing Adults: the Practice of Caring, Mosby, 2003.

C3996_04.qxd 26/02/2004 13:53 Page 41

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

Time (hrs)

Fluid intake

Oral

Other (specify route)

Fluid output

Urine Vomit

01.00

Other (specify)

TOTAL

Hospital/Ward:

Date:

Hospital number:

Surname:

Forenames:

Date of birth:

Sex:

Fluid balance chart

02.00

03.00

04.00

05.00

06.00

07.00

08.00

09.00

10.00

11.00

12.00

13.00

14.00

15.00

16.00

17.00

18.00

19.00

20.00

21.00

22.00

23.00

24.00

Fig. 4.2

Fluid balance chart. Reproduced with permission from Nicol

et al, Essential Nursing Skills, Mosby, 2000.

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Medicine/drug chart
It is important for you to become familiar with the medicine/
drug-related documents used in your area of practice. A basic
medication record will contain the patient’s biographical infor-
mation, weight, history of allergies and previous adverse drug
reactions. There will be separate areas on the chart for different
types of drug orders. These include:

— drugs to be given once only at a specified time, such as a seda-

tive before an invasive procedure

— drugs to be given immediately as a single dose and only once,

such as adrenalin (epinephrine) in an emergency

— drugs to be given when required, such as laxatives or anal-

gesics (pain killers)

— drugs given regularly, such as a 7-day course of an antibiotic

or a drug taken for longer periods (e.g. a diuretic or a drug to
prevent seizures).

All drugs, except a very few, are ordered using the British

Approved Name, and the order (or prescription) will include the
dose, route, frequency (with times), start date and sometimes a
finish date. There is space for the signature of the nurse giving
the drug and, in some cases, the witness. It is vital to record when
you give a drug. This is done at the time so that all staff know
that it has been given, and do not repeat the dose. Likewise, if
you cannot give the drug for some reason (e.g. patient is in
another department or their physical condition contraindicates
giving the drug), make sure that this fact is recorded on the med-
icine/drug chart and the doctor is informed if necessary.

Remember that in some situations you will need to record in

the nursing notes when you give patients a drug (e.g. if you give
analgesic drugs (pain killers)).

Informed consent
Responsibility for making sure that the person or the parents of a
child have all the information needed for them to give informed
written consent rests with the health practitioner (usually a doctor

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or nurse) who is undertaking the procedure or operation. This
information will include:

— information about the procedure/operation
— the benefits and likely results
— the risks of the procedure/operation
— the other treatments that could be used instead
— that the patient/parent can consult another health practitioner
— that the patient/parent can change their mind.

Young people can sign the consent form once they reach the

age of 16 years and/or have the mental capacity to understand
fully all that is involved. If the young person cannot sign the form,
the parent or legal guardian may sign it. If an adult lacks the men-
tal capacity, either temporarily or permanently, to give or deny
consent, no person has the right to give approval for a course of
action. However, treatment may be given if it is considered to be
in the person’s best interests, as long as an explicit (clear) refusal
to such action has not been made by the person in advance.

Doctors do most invasive procedures and operations, but nurs-

es in the UK are extending their practice to include many proce-
dures that were previously done by doctors. You may work with
nurses who do procedures such as endoscopic examinations, so
it is becoming more common for nurses to obtain informed con-
sent. The patient or parent and the healthcare practitioner both
sign the consent form.

When your patients are due to have any invasive procedure,

always check their level of understanding before it is scheduled
to happen. If you are not sure about answering a question, ask
the healthcare practitioner who is doing the procedure to see the
patient and explain again. It is essential that the consent form is
signed before the patient is given a sedative or other premedica-
tion drugs.

Incident/accident form
Any non-routine incident or accident involving a patient/client,
relative, visitor or member of staff must be recorded by the nurse

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who witnesses (sees) the incident or finds the patient/client after
the incident happened. Incidents include falls, drug errors, a vis-
itor fainting or a patient attacking a member of staff in any way.

An incident/accident form should be completed as soon as

possible after the event. Careful documentation of incidents is
important for clinical governance (continuous quality improve-
ment, learning from mistakes and managing risk, etc.) and in case
of a complaint or legal action (see above).

The following points provide you with some guidance:

— be concise, accurate and objective
— record what you saw and describe the care you gave, who else

was involved and the person’s condition

— do not try to guess or explain what happened (e.g. you should

record that side rails were not in place, but you should not
write that this was the reason the patient fell out of bed)

— record the actions taken by other nurses and doctors at the time
— do not blame individuals in the report
— always record the full facts.

Guidelines for documentation and record keeping

The basic guidelines for good practice in documentation and
record keeping apply equally to written records and to computer-
held records.

The Nursing and Midwifery Council (NMC 2002) has said that

patient and client records should:

— be based on fact, correct and consistent
— be written as soon as possible after an event has happened to

provide current (up to date) information about the care and
condition of the patient or client

— ‘be written clearly and in such a way that the text cannot be

erased’ (rubbed out or obliterated)

— be written in such a way that any alterations or additions are

dated, timed and signed, so that the original entry is still clear

— ‘be accurately dated, timed and signed, with the signature

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printed alongside the first entry’ (this is even more important
because your last name may not be very common in the UK)

— ‘not include abbreviations, jargon, meaningless phrases, irrele-

vant speculation and offensive subjective statements’

— ‘be readable on any photocopies’.

Note: Although the NMC guidelines clearly state that abbrevia-

tions should not be used in patient/client records, because you
will see and hear abbreviations used in medical notes and han-
dover reports, a list of commonly used ones is provided in
Chapter 9 to help you understand what people mean.

The NMC goes on to say that records should:

— ‘be written, wherever possible, with the involvement of the

patient, client or their carer’

— ‘be written in terms that the patient or client can understand’
— ‘be consecutive’ (uninterrupted)
— ‘identify problems that have arisen and the action taken to rec-

tify’ (correct or put right) them

— ‘provide clear evidence of the care planned, the decisions

made, the care delivered and the information shared’.

OTHER WRITTEN COMMUNICATION

Letter writing

Letters may be professional, business or private. The private type
is obviously easier to write, but there are, nevertheless, certain
basic rules to be remembered.

The envelope
— It is becoming increasingly common in the UK to put the

sender’s name and address on the back of the envelope, par-
ticularly when sending packages and important documents.
However, most people in the UK throw away envelopes as
soon as letters are opened, so if you want an answer you must
write your full address on the letter itself.

— It is correct to address people as Mr, Ms, Mrs or Miss with ini-

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tials and last name (e.g. Miss J Smith or Mr O Massoud). Many
women prefer to be addressed as Ms, regardless of marital sta-
tus, and certainly Ms should be used where you are unsure. A
married woman or a widow may be addressed as Mrs unless
she has some other title or is known to prefer Ms. An unmar-
ried woman may be addressed as Miss. There is a growing ten-
dency to omit the title completely and simply use the name
(Jill Smith or Omar Massoud) on the envelope. Other titles,
such as Professor or Dr, should be used if appropriate.

— When writing a professional or business letter to a college, a

company, an hotel, a professional journal, etc., the letter must
be addressed to someone. You would, in fact, write to the
Principal of a college, to the Secretary or Manager of a com-
pany, to the Manager or Receptionist of an hotel and to the
Editor of a professional journal.

— The address follows the name, in this order:

i. the number of the house and the name of the street (on

the same line), or the name of the house (e.g. Allgoods
Cottage) with the street name on a separate line

ii. village, town or city
iii. county (and country if written from abroad)
iv. postal code.

For example:

Ms C Gower

116 Tenby Drive

Fakenham

Norfolk

PE57 1ZZ

As can be seen from the above example, usual practice is to omit
punctuation from the details of the name and address. On word-
processed or typewritten letters, indentation is no longer used.

The letter
— The sender’s address is written in full at the top right-hand side

of the paper. It is not usual to put your name there. In care

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homes and hospitals and other places where official writing
paper is printed, the address, including the telephone num-
ber and e-mail address, is either on the right-hand side or in
the centre.

— In private letters the date is usually written below the sender’s

address in the order: day, month, year (e.g. 7 June 2006, or
sometimes as 7.6.2006).

— In a professional or business letter, the name and address of

the person to whom the letter is written are placed on the left-
hand side, at the top, with the date written below the address.

— When you write to an unknown person the letter begins ‘Dear

Sir’, or ‘Dear Madam’ if it is to a woman. If you are unsure,
write ‘Dear Sir/Madam’.

— When you have met the person or corresponded before, the

last name is used and the letter begins with ‘Dear Dr Sanchez’.
If you know the person well or they have signed previous let-
ters to you with their first name it is usual to address them by
their first name (e.g. ‘Dear Rao’).

— When writing to a friend, one begins ‘Dear John’, ‘Dear Farida’,

or ‘My dear Elizabeth’, to a closer friend.

— If the letter begins ‘Dear Sir or Madam’, the ending should be

‘Yours faithfully’.

— If the letter begins, ‘Dear Ms Steele’ or some other name in a

professional or business correspondence, the ending should
be ‘Yours sincerely’.

— ‘With best wishes’, ‘With kindest regards’ or ‘Yours’ are quite

usual endings for letters to friends, or colleagues who you
know well.

— Phrases such as ‘Yours respectfully’ are no longer used. Nor is

it UK practice to use very flowery, effusive (over the top) lan-
guage in a professional or business letter. Write clearly and
simply and briefly in a professional or business letter.

— Each new subject or aspect of the subject should be dealt with

in a separate paragraph. In a handwritten letter the para-
graphs are marked by starting a little distance from the left
side, or in word-processed letters by leaving space between

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the paragraphs.

— It is important to print your name in block letters underneath

your signature, as names are often very difficult to read in
handwriting. Also, note that in the UK the numbers one and
seven are written thus: 1, 7. Figures written in the style used
in continental European countries may cause delay, and even
loss, to correspondence

— In situations where you have written asking for information

such as details of a course, the institution may write to thank
you for your interest and ask you to send an envelope with
your address and enough postage stamps (stamped addressed
envelope), so they can send you the printed material. The
request for such an envelope is usually abbreviated to ‘please
send/enclose an SAE’.

Writing electronic mail

The use of electronic mail (e-mail) is increasingly important for
both professional and private communication. The following list
provides you with some guidance:

— Remember that e-mail cannot be 100% secure or confiden-

tial – it may be read by other people. It is especially important
to make sure that e-mail containing patient/client details is
only seen by those authorised to do so. Always follow the
local protocols for keeping computer records confidential.

— It is important to be concise. People often get many e-mails

each day and you want them to read yours.

— It is good sense to think before you send any written commu-

nication – you can change your mind right up to putting a let-
ter in the postbox, but once you click on post/send for e-mail
it is too late to change your mind. Feeling upset or angry is not
an ideal time to send an e-mail.

— In common with professional or business letters, it is usual to

address people as Mr, Ms, Mrs, Miss, Dr, etc., unless you know
them well and generally use their first name.

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— It is not appropriate to use e-mail abbreviations (e.g. ‘BTW’ for

‘by the way’) or nursing/medical abbreviations in professional
e-mail. Not everyone will know what the abbreviation means,
or an abbreviation may have more than one meaning.

— It is not necessary to overuse punctuation in e-mail, such as

using many exclamation marks. It is much better to let your
text emphasise the important points. Likewise, it is not usual
to use upper case (capital) letters for whole words, as this is
the e-mail equivalent to shouting.

— A reply is not always instant. It is important to remember that

although e-mail usually reaches its destination in just a few
minutes, it can take longer. Some people read and reply to
their e-mail several times a day, but others may only check
once a week.

REFERENCES

Nursing and Midwifery Council (NMC) 2002 Guidelines for

records and record keeping. NMC, London.

FURTHER READING

Hoban V 2003 How to ... handle a handover. Nursing Times

99(9):54–55.

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Communication in
nursing

INTRODUCTION

Being able to communicate is an essential skill for all health pro-
fessionals and it is particularly important for nurses who are with
people and their families for many hours a day. It is not always
easy to understand what people are saying or to get them to
understand what you are trying to tell them. Sometimes nurses
who qualified in the UK have difficulties understanding people
who have regional accents and many patients use different words
for feelings and everyday events. Some of these words are part of
this chapter, and Chapter 6 (Colloquial English) gives you lots
more examples.

Nurses need to communicate so they can find out about the

people in their care by taking a nursing history, give them infor-
mation about their care and teach them about managing their
illness.

This chapter will help you with some of the questions needed

to take a nursing history and plan care based on a commonly
used Activities of Living Model of Nursing (see Roper et al 1996)
and some other important nursing issues (e.g. confusion and anx-
iety). Short case histories that focus on a particular activity are
included to help you with some common situations. There are
extracts from dialogues (conversations) between nurses and peo-
ple/clients/relatives that give you examples of what they may say
to you in answer to your questions. These case histories will be
useful when you deal with similar situations at work, and later
reflect on the positive and negative features of a particular con-
versation you had with a patient/client and their family.

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Note: All the people and case histories used are fictitious and

are not based on any persons we have nursed or met when
supervising students

GETTING STARTED

The first words you say to a person are very important – you need
to get it right. You need to say who you are and why you are
there. What you say will depend on the situation, but you might
start with:

‘Hello [or good morning/good evening] Mrs Jones I am Nurse [your

last name/surname/family name].’

or just use your first and last names and say that you are the
nurse who will be caring for them for the shift (or whatever is
appropriate).

Ask Mrs Jones what she likes to be called. You will hear

patients and nurses using lots of different forms of address; for
example, the titles Mr, Ms, Miss, Mrs or Dr with the last name, or
first names, or sometimes endearments such as love, dear, gran,
nan, grandpa, honey, darling, mate, pet, hen, duck, etc. As a gen-
eral rule it is not acceptable to use endearments when speaking
to patients. Do not use a person’s first name unless they ask you
to do so. It is important to follow a person’s wishes about their
preferred form of address – make sure that this is written in the
nursing notes for all nurses to read.

Once you know what the person wants to be called you can

start to get the information needed to plan nursing care, explain
the care, tests or treatment planned, and answer any questions.
Remember that if you cannot answer a person’s question it is
important to get another nurse, doctor or other healthcare pro-
fessional to do so.

Whenever possible ask simple questions that will ensure you

get the exact information needed, and avoid using jargon. For
example, saying to Mrs Jones ‘I will be back to do your vital signs
or obs’ will mean nothing to her – you will need to explain that
you will be back to record her blood pressure, temperature, pulse

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and respiration. Always check any prepared documents that
arrive from the admissions office or the emergency department –
the person’s details may have changed or there might be a
mistake.

Biographical data

— You will need to start with the assessment sheet, finding out

details about your patient such as their full name, where they
live (address) and who with.

‘Mrs Jones can you tell me your full name [first name or forename

followed by last name which is also called the surname or family

name] and your address and telephone number.’

If you ask where they live patients might say ‘In the town’ or
‘With my husband’, so it is best to ask for the address (house
number/name, the street, the town, county and the postcode,
see Ch. 4). If you have problems spelling a name or address,
always ask the patient or their relative to spell it out letter by
letter or even copy it out for you – it must be accurate. It is
important to ask your patient’s age and date of birth, e.g.
57 years, 22/2/1946. In the UK dates are always written in the
order day, month and year.

— Always ask the name and address of the patient’s next of kin,

and get telephone numbers (daytime and for use at night) in
case it is necessary to contact family members. Obviously this
might be necessary if the patient’s condition worsens, but it
might be to say that the person can come home so please can
the family bring in outdoor clothes. If the next of kin lives
many miles away the patient may give you contact details of a
friend or neighbour (someone living close to them).

— An assessment includes asking about the patient’s religion (if

any) or spiritual needs, so you can plan care that ensures any
religious, spiritual or cultural needs are met. These needs may
include attending a religious service/ceremony, having a visit
from a religious leader, priest, minister, mullah, rabbi, etc., or

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having facilities for prayer, needing to fast or having special
food.

‘What religion are you Mrs Jones?’

Then you can ask appropriate questions, such as

‘Will you want to see your minister or visit the hospital chapel?’

In the UK many patients will answer with the abbreviation for
their religion, e.g. ‘C of E’ for Church of England or ‘RC’ for
Roman Catholic.

Work (employment) history

You will need to ask the patient if they work. This usually means
paid work, but many people in the UK do unpaid voluntary work
and this should also be recorded on the assessment form.

Once you know that the patient works you can get more

details. The type of work may be influencing their health (e.g.
exposure to substances such as asbestos that can cause cancer,
work in a dusty environment and chest diseases, or back pain
where heavy objects must be moved). The length of time off
work following an operation will depend on the type of work the
patient does, and in some situations patients cannot go back to
their old job (e.g. some driving jobs following a heart attack
(myocardial infarction)).

The question:

‘What do you do?’

usually means ‘What is your work?’. Patients may tell you where
they work (i.e. the company name) rather than the type of job
they do. So if they say

‘I’ve been at Clarks since I left school and that’s nearly 30 years’

you will have to ask:

‘What job do you do at Clarks?’

‘Do you work full time or part time?’

‘How many hours do you work in a week?’

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‘Do you work shifts?’ (This relates to irregular hours, e.g. in a

hospital or factory.)

‘How long have you been doing this job?’

‘Do you have a stressful job? ‘Do you work late or have to take

work home?’

If patients are not working you need to find out why – are they
retired from work and, if so, ask what type of work they used to
do, looking after children or a relative, looking for work, study-
ing or unable to work for health reasons.

Reason for admission or contact with health services and
medical details

— The patient’s understanding of reason for admission/treat-

ment, etc. It is important to find out exactly why the patient
thinks they have visited the general practitioner/practice nurse,
or come into hospital or the care home. It might be correct to
ask a direct question such as:

‘What do you think is the matter with you?’

‘Tell me why you have come in today.’

This last type of comment might be used for a patient coming
in for a planned operation. The patient may say something
like

‘I’ve come in to get my cataract done [operated on].’

Sometimes you will need to use questions such as:

‘Have you been having some problems at home?’

and the patient may say:

‘I’ve been having dizzy turns [vertigo] when I keel over [fall over].’

‘I had a spell [a period of time] of feeling very down [depressed

mood] but that has cleared up [got better, disappeared] now.’

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You will also need to check that the family know why the
patient has been admitted.

— Past medical history and family history. You will need to ask

about past illnesses or operations. For example, a patient com-
ing in for a routine operation may have type 1 diabetes or they
may have severe arthritis that makes walking very difficult and
you will need to plan care accordingly. You might ask:

‘Have you ever had any serious illnesses in the past?’

‘Have you ever had an operation?’

‘Have you ever been in hospital before?’

‘Have you ever had any accidents or injuries?

‘Is there anything else you’d like to tell me?

As some illnesses, such as some types of heart disease and dia-
betes, may run in certain families (familial) you will also need
to ask about the family medical history:

‘Are there any serious illnesses in you family?’

— Allergies. Always ask about any allergies, including foods, drugs

(see below) and other substances such as washing powders:

‘Are you allergic to anything?’

‘Have you any allergies?’

It might be necessary to ask the family, for example, if the
patient is a child, has dementia or is unconscious.

— Drugs. It is necessary to ask all patients/clients if they are tak-

ing any drugs, but it is worth remembering that some patients
will associate the word ‘drugs’ with illegal substances and drug
misuse, so you can ask:

‘Are you taking any medicines (or drugs)?’

Always ask patients about all types of drugs, including those
prescribed by a doctor or nurse, drugs they buy at the chemist
(pharmacy) or supermarket (over-the-counter drugs), natural
remedies such as St. John’s Wort, and if appropriate ask about
recreational (illegal) drugs such as cannabis. It is vital to know

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about any drug allergies (e.g. penicillin) or adverse drug reac-
tions. Always ask and make sure that this is recorded in all the
relevant nursing documentation.

Physical function and effects of current illness on daily living
or work

Many areas of physical function, such as mobility (moving about),
are covered in the dialogue section (see pp. 59–123), but you will
need to ask how the current illness affects everyday life.

For example:

‘Is there anything you need help with at home, such as getting out of

bed or making a cup of tea?’

‘How often does your neighbour come in to help you?’

‘Are you still able to work?’

Social history

— Support networks are important particularly after discharge.

You can ask questions that include:

‘Do your family live close by?’

‘Who will be at home to look after you when you are discharged?’

‘Will you be able to stay with your family until you are able to

manage back at home?’

— Type of home. Although you know the patient’s address, you

also need to know about the type of home they have. Patients
who live alone in a big house may be unable to keep it heat-
ed or clean after discharge, and a patient who lives in a flat up
several flights of stairs may need to be found a ground-floor
flat before they can go home. You will need to ask questions
that include:

‘Do you live in a house, bungalow, flat, bedsit, etc.?’

(A bedsit is a room used for both sleeping and daytime activ-

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ities with the use of shared kitchen and bathroom.)

‘How do you heat your home?’

(Patients may not be able to manage an open fire or may not
use expensive heating if they are living on a low wage, pen-
sion or benefits.)

‘Do you have good neighbours?’

(The patient may be relying on the neighbours to check the
house, feed pets, take in post and do things like cutting the
grass while they are in hospital.)

— Social problems due to present condition/admission. Patients

admitted as an emergency may be worried about children or
others such as older relatives at home who depend on them.
Many people in the UK have pet animals such as a cat or dog
and you should always ask if they have a pet, and if someone
is caring for them.

‘Do you have any pets at home?’

‘What’s your cat’s name?’

‘Who is feeding Harry?’

You will need to listen very carefully, as a patient with
dementia, for example, may keep repeating the name of the
pet animal rather than tell you the details. Patients can be very
anxious about the care of their pet animals while they are in
hospital or a care home.

— Hobbies and interests.

‘How do you spend your free time?’

‘How much exercise do you take?’

‘Do you play any sports?’

‘Have you any hobbies?’

‘Do you like to watch TV [television] or listen to music?’

— Contacts with and input from other health and social care

professionals. Many older patients will already be in contact

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with a wide range of health and social care professions, such
as a district nurse, health visitor, practice nurse, general prac-
titioner (family doctor), physiotherapist, occupational thera-
pist, speech and language therapist, dietician, podiatrist or
social worker. You should ask about this and find out who
comes, how often and what they do:

‘Do you see the nurse at home?’

‘What do the nurses do?’

‘Do they come in everyday?’

Lifestyle

During the nursing assessment you will need to find out about
lifestyle or behaviour that can influence health in both good or
bad ways (e.g. the type of foods eaten, amount of exercise, alco-
hol intake, use of drugs, use of tobacco, sexual behaviour and
high-risk leisure activities). Often a person’s lifestyle or behaviour
is sensitive and they may feel embarrassed or guilty if you ask lots
of questions. Thus direct questioning does not always work well
in this situation, but often you will be able to get the information
as the patient talks about their lifestyle and view of health. For
example, a patient may tell you, without any prompting, that they
know they do not get enough exercise and you can find out more
by asking them what they mean. Sometimes, however, you will
need to ask more directly and the sort of questions that may be
needed to get information about some of these lifestyle issues are
discussed in the following section under the related activity.

BREATHING

Some nursing/medical or Standard English words and correspon-
ding colloquial words and expressions associated with breathing
are given in Box 5.1.

Note: Colloquial expressions used in the case histories and

example conversations are explained in brackets […].

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Mr Ryan has been admitted to the medical assessment unit with
a chest infection causing an exacerbation [worsening] of his
chronic obstructive pulmonary disease (COPD). He is very dis-
tressed and finding it hard to breathe. His wife tells you that ‘His
breathing has been bad for years and he can’t get about much
these days’ – meaning that his mobility is reduced. You can get
the biographical data from Mrs Ryan, and as soon as Mr Ryan’s
condition improves you can find out more about his breathing
and related problems. You might also want to ask Mrs Ryan if
her husband becomes confused or mixed up [disorientated], as
this may be a sign of reduced oxygen getting to the brain
(caused by hypoxia), or if he is more drowsy [sleepy] than nor-
mal. This may happen if there is too much carbon dioxide in the
arterial blood (hypercapnia).

Nurse:

Mrs Ryan have you noticed a change in your husband’s
mental state recently, does he get confused?

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

Box 5.1

Words associated with breathing (for further examples

see Ch. 6)

Nursing/medical or

Colloquial (everyday) or slang (very informal)

Standard English words

words and expressions used by patients

Dyspnoea

Breathlessness; out of breath; puffed; short of

breath; fighting for breath (severe cases)

Expectorate

To bring up/cough up phlegm; spit

Expiration

Breathing out

Inhaler for drugs

Puffer

Inspiration

Breathing in

Respiration

Breathing

Sputum

Phlegm (pronounced flem)

Case history – Mr and Mrs Ryan

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Mrs R.: Now you come to mention it he does seem a bit dotty

[silly] sometimes. You know, not always knowing
where he is.

Nurse:

Hello Mr Ryan tell me about the problems you have with
your breathing.

Mr R.:

I’m breathless most of the time but the infection
made it much worse – I was really frightened and felt
that I was fighting for breath until the treatment (more
bronchodilators, corticosteroids and antibiotic therapy)
started to work [became effective].

Nurse:

Before the infection how was your breathing? Were you
breathless sitting still?

Mr R.:

Oh no, only when I tried to walk about.

Nurse:

Can you normally get upstairs in one go [without
stopping]?

Mr R.:

Only if I rest on the landing [flat part of a staircase] and
get my breath back [recover].

Nurse:

How far can you walk on the level without getting
breathless?

Mr R.:

I can get as far as the back garden but I’m fair jiggered
[exhausted, breathless] after.

Nurse:

Is there anything else about your breathing? Do you
wheeze [make an audible noise when breathing]?

Mr R.:

Yes, I do wheeze and my chest often feels tight,
but Dr Singh is going to put me on something new
[prescribe a different drug], so hopefully that will do
the trick [hopes the new treatment will be effective] –
fingers crossed [hope for good luck].

Nurse:

Hope so.What medicines were you taking at home before
you came into the ward?

Mr R.:

The blue inhaler [salbutamol inhaler], and the antibiotics
from the GP for the infection.

Nurse:

Are you using oxygen at home?

Mr R.:

Yes, for up to 15 hours a day. It’s OK, we have a
machine that takes some gases out of the air and
leaves the oxygen [oxygen concentrator] for me, so the

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missus [wife] doesn’t need to keep changing cylinders
and I can get around in the house and out as far as the
back garden.

Nurse:

What else helps your breathing?

Mr R.:

Well – sitting up and leaning on the table helps, but
when I’m very chesty [trouble with chest, coughing] it’s
better to sleep downstairs in an armchair. At least the
wife gets some sleep even if I don’t. A while ago I
started doing relaxation exercises and that helps when
I feel panicky [frightened], but they didn’t work last
night – worse luck.

Nurse:

Do you still smoke?

Mr R.:

No, not for years.

Nurse:

When did you stop smoking?

Mr R.:

I used to smoke roll-ups [cigarettes that the patient
makes himself] and I cut myself down [reduced the
number of cigarettes] to 10 a day, and then I said
‘That’s it. No more’ and I haven’t smoked for 5 years.
It was hard but I was determined to stick to [keep to]
no smoking.

Nurse:

That’s good, but do you still cough?

Mr R.:

Yes, cough and bring up stuff [phlegm or sputum]. I
had a smokers’ cough [early morning cough] when I
was in the Army, but now I cough any time of the day
or night.

Nurse:

What colour is the sputum you cough up? Has the amount
increased?

Mr R.:

Really green because of the infection, and much more,
and my mouth tastes foul.

Nurse:

We sent a specimen to the laboratory earlier, so I’ll get you
some sputum pots and tissues and some mouthwash.The
physiotherapist is on his way up to see you, so he will help
you to cough and clear your chest. Do you have any pain
with the cough?

Mr R.:

Not at the moment.

Nurse:

What about washing and dressing – are you able to manage

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or do you need some help?

Mr R.:

Just need some help to wash my back and feet. She
does it at home [meaning Mrs Ryan helps].

Nurse:

How is your appetite? What about eating and drinking?

Mr R.:

I’m trying to have a drink every hour like you said, but
I can’t face [manage] a big meal.

Nurse:

I will ask the dietician to visit and discuss it with you, but
for today I can give you some nourishing drinks and order
snacks or light meals for you.

Mr R.:

Thanks, that sounds spot on [exactly right].

Nurse:

Your bed is close to the bathroom and lavatory.Will you be
able to walk or will a wheelchair be easier?

Mr R.:

It’s not far – I can get there, but after washing I might
need some help back.

Nurse:

How are you sleeping?

Mr R.:

Don’t worry I’ll sleep OK tonight – after today with
having to call the ambulance and everything I’m
knackered [exhausted].

Nurse:

Is there anything you would like to ask me?

Mr R.:

No thanks. You and the doctor explained what was
going on [happening] earlier and I do understand about
COPD. An ‘expert patient’ you might say.

Nurse:

Just ring the bell if you need me. I think Mrs Ryan went to
phone your son and have a cup of tea while we did the
paperwork. I’ll bring her in to you when she gets back.

Other questions
Mr Ryan will find it difficult to talk for long if he is breathless, so
you may need to ask some other questions later. Sometimes it will
not be necessary to ask because Mr Ryan may tell you extra
things as you are attending to his care or he may tell other health
professionals, such as the physiotherapist.

Other questions may include some of the following:

‘Do you have pain or chest discomfort on breathing or coughing?’

‘Do your ankles get swollen?’

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‘Is there anything that makes you cough worse, such as a smoky or

dusty atmosphere, or changes in temperature like going out into the

cold? Does any position make it worse?’

‘Have you noticed any blood in your sputum?’ Is there a lot of blood

or is it streaked with blood?

COMMUNICATING

Some nursing/medical or Standard English words and correspon-
ding colloquial words and expressions associated with communi-
cating are given in Box 5.2.

Note: Colloquial expressions used in the case histories and

example conversations are explained in brackets […].

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

Box 5.2

Words associated with communicating (for further

examples see Ch. 6)

Nursing/medical or

Colloquial (everyday) or slang (very informal)

Standard English words

words and expressions used by patients

Diplopia

Double vision; seeing double

Dysarthria

Can't get the words out

Dysphasia (aphasia)

I know what to say but nothing comes out; I

can't find the right word; the sentence comes

out all wrong; I can say the word but I don't

know what it means

Hearing impairment,

Hard of hearing; deaf as a post

deafness

Tinnitus

Ringing, buzzing or roaring sound in the ears

Visual impairment,

Can't see the hand in front of me; blind as a bat

blindness

Vertigo

Dizzy; dizziness; giddy

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Mrs Egbewole had a stroke (cerebrovascular accident) about
18 months ago, and her family, with the help of twice-daily visits
from the home carer, usually look after her at home. She has
come into the care home while her family has a short holiday.
The stroke has left Mrs Egbewole with left-sided paralysis and
poor balance. She does not have dysphasia, but because the left
side of her face is also paralysed she sometimes has slurred
speech and dribbles saliva. She also has problems with non-
verbal communication because her facial expression is affected.

Nurse:

Mrs Egbewole, do you have any problems with your speech?

Mrs E.: It is slurred sometimes, but that’s because my mouth

doesn’t work properly.

Nurse:

How does that make you feel?

Mrs E.: I feel really embarrassed, especially if I’m talking to

someone new.

Nurse:

How can we help?

Mrs E.: I’ll be all right as long as [provided] people give me

enough time to get the words out. It gets me flustered
[agitated/confused] if people are impatient’

Nurse:

I’ll make sure that is recorded in your care plan and that all
members of staff know to give you plenty of time to tell us
things. Did you see the speech and language therapist after
the stroke?’

Mrs E.: Yes, but I couldn’t handle it [cope] so soon after losing

my husband [my husband died].

Nurse:

How would you feel about trying again with speech and
language therapy?

Mrs E.: If you think it might help I’m willing to give it another

go [try again].

Nurse:

Fine – I’ll organise a referral. Is there anything else that’s
troubling you?

Mrs E.: Well yes there is, and it’s all down to [caused by] the

muscles in my face not working properly. I can’t help
dribbling [saliva flows from the mouth].

COMMUNICATION IN NURSING

Case history – Mrs Egbewole

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Nurse:

You obviously know about keeping the skin round your
mouth clean and dry because there is no sign of soreness.

Mrs E.: Yes, the nurses on the stroke unit really stressed good

skin care. But another thing that worries me is the look
of my face – it’s really lopsided [asymmetrical] and
when I try to smile I must look dreadful.

Nurse:

Maybe the speech and language therapist can suggest
something to help, but you could mention it to Dr Newell.
She will be in this afternoon.

Mrs E.: That’s a good idea – I will add it to my list of questions

I have for her.

Nurse:

How is your sight? I see you have spectacles/glasses on at
the moment.

Mrs E.: Yes, I’m blind as a bat without them [usually meaning

poor vision rather than completely blind] and have
needed help for years. I used to have contact lenses,
but after my stroke I found it too difficult to take them
out, so I got some specs [short for ‘spectacles’].

Nurse:

Do you have a second pair for reading or does the one
pair do for everything?

Mrs E.: They are bifocals and I am supposed to look through a

different bit for reading. But if the print is very small,
such as on food labels, I use a magnifying glass instead.

Nurse:

Did you bring the magnifying glass in with you?

Mrs E.: Oh yes, my carer packed everything but the kitchen

sink [implies that the carer was very thorough when he
packed Mrs Egbewole’s suitcase].

Nurse:

Who normally cleans your spectacles?

Mrs E.: My lovely [meaning admirable in this case] carers do

that, I can’t with only one good hand.

Nurse:

Would you like me to give them a clean now?

Mrs E.: Thanks – they’re not very clean and it makes things

look blurred.

Nurse:

Do you have any other problems with your eyes?
Sometimes a stroke can affect vision, such as seeing
things double.

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Mrs E.: Oh no, I was lucky [that the stroke did not affect her

sight]. When I was younger I suffered terribly [very
badly affected] with migraine and then I used to see
flashing lights with a zigzag pattern before the
headache came on [started]. If I’m out in a cold wind
my eyes start running [watering; tears flow down the
cheeks], but that’s normal.

Nurse:

Definitely normal – it certainly happens to me.

Mr Sandford is 42 years old and has poor hearing, tinnitus and
problems with the build-up of earwax, which also affects his
hearing. He has Down syndrome and lives independently at the
local group housing complex where he has a bedsit. He works
full-time in a supermarket. His parents are dead, but his two older
sisters, who live close by, see him several times a week and he
has many friends from work and in the house.

Nurse:

Hello Mr Sandford, I’m Nurse MacGregor. I understand that
you have come to see us about your hearing.

Mr S.:

Hello, everyone calls me Nick. My hearing is no good,
I can’t hear them on the telly [television] or the boss
[manager] at the shop.

Nurse:

Can you hear me all right?

Mr S.:

Yes.

Nurse:

What would you like me to call you?

Mr S.:

You can call me Nick if you like.

Nurse:

OK. Has your hearing always been bad Nick?’

Mr S.:

Not as bad – it’s really bad now and I can’t hear the telly.

Nurse:

What do you like on the telly?

Mr S.:

I watch Eastenders and Coronation Street [both popular,
long-running series in the UK], they’re the best and I
like the football as well.

Nurse:

What helps you to hear?

Mr S.:

Like now when I can see you and nobody else is
talking. When I’m calm.

COMMUNICATION IN NURSING

Case history – Mr Sandford

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Nurse:

Anything else?

Mr S.:

The ear wash [ear irrigation, previously known as
‘syringing’] but it feels funny [strange].

Nurse:

We can have a look inside your ears with the special light
[otoscope] to check for wax, you might need another ear
wash to help you hear.

Mr S.:

OK.

Nurse:

Have you got a hearing aid?

Mr S.:

Don’t like it.

Nurse:

What don’t you like?

Mr S.:

It’s broken.

Nurse:

Have you got it with you? Perhaps the technician can
mend it.

Mr S.:

Here it is, but it’s no good.

Nurse:

I’ll take it to the technician in a bit [in a short while]. Does
anything else happen as well as not being able to hear?

Mr S.:

Roaring [loud noise] and buzzing [like the sound made
by insects] in my ears.

Nurse:

Anything else?

Mr S.:

My ears feel stuffed up [fullness] and I get giddy
[experience vertigo] and stagger.

Nurse:

Do you fall over?

Mr S.:

I know it’s coming, so I sit down.

SAFETY AND PREVENTING ACCIDENTS

Some nursing/medical or Standard English words and correspon-
ding colloquial words and expressions associated with safety and
preventing accidents are given in Box 5.3.

Note: Colloquial expressions used in the case histories and

example conversations are explained in brackets […].

Mrs Kaur has scalded her arm while making a cup of tea. Her
neighbour brought her to the Emergency Department after they

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had bathed the damaged area with lots of cool water and kept it
cool on the way to hospital with a wet towel. She is upset about
being so clumsy and feels that she has been a nuisance to her
neighbour and to the hospital staff who already have enough to
do. Luckily the skin damage is superficial and should be com-
pletely healed in a few days.

Nurse:

Hello again Mrs Kaur. Have the painkillers worked [taken
away the pain]?

Mrs K.: Hello Nurse. Yes, the pain is much less. My arm just

feels sore [tender].

Nurse:

The plan is to keep the scald dry and warm and let it heal.
I’ve come to put a dressing on your arm.

Mrs K.: I don’t want anything that will stick.
Nurse:

The dressings we use don’t stick anymore, they are made
to be non-adherent.

Mrs K.: I remember the pain years ago when dressings did stick.
Nurse:

The dressing only needs to be on for a few days and the
scald will heal. It was a good thing that you knew the first
aid for scalds, cooling the skin down certainly stopped it
getting any worse.

COMMUNICATION IN NURSING

Box 5.3

Words associated with safety and preventing accidents

(for further examples see Ch. 6)

Nursing/medical or

Colloquial (everyday) or slang (very informal)

Standard English words

words and expressions used by patients

Fall

Took a tumble; lost my footing; tripped up

Fracture

Broken or cracked (as in bone)

Seizure

Fit; funny turn; convulsion; an attack

Sprain

Twisted (as in ankle)

Syncope

Fainting attack; black out; collapse; pass out

Unconscious

Knocked out (KO'd); out cold; dead to the

world; out of it

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Mrs K.: I saw a thing on the telly [television] about what to do

with burns. But what about some burn ointment? It
must need something.

Nurse:

If you leave the dressing on for 2 or 3 days the scald will
heal without any other treatment.You can take mild
painkillers such as paracetamol if your arm is sore.

Mrs K.: I don’t like the idea of taking it [the dressing] off

myself.

Nurse:

Well today is Saturday, so it should all be healed by
Monday.You can get an appointment with the practice
nurse for Tuesday and she can take off the dressing and
check your arm.

Mrs K.: Sounds sensible – I will do that. I really feel such a

fool – how could I pour boiling water over myself. I
am doing all the silly things my granny [grandmother]
did when she was 80.

Nurse:

How do you think it happened?

Mrs K.: I can’t seem to judge where the cup is. It’s the same

when I pour orange juice into a glass. And the kettle is
so heavy.

Nurse:

Have you had your eyes checked recently?

Mrs K.: My routine test must be due very soon – I will phone

on Monday.

Nurse:

Could you talk to the practice nurse about the trouble
[difficulty] you have when pouring fluids?

Mrs K.: Yes, do you think I should tell her about how things

are blurred and sometimes lines look very odd and
wavy?

Nurse:

That sounds like a good idea. But what can you do to make
the kettle easier to use?

Mrs K.: I forget it’s only me having a drink and usually fill it

too full.

Nurse:

Yes, I just fill mine without thinking. I have seen smaller
kettles. Perhaps you would find that easier.

Mrs K.: My daughter can get me one when she goes to the

big shops.

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Mr Anderson is going home with several different drugs. He has
been in hospital to have intravenous antibiotics for cellulitis and
needs to have a course of oral antibiotics (phenoxymethylpeni-
cillin, flucloxacillin and metronidazole). He also takes an
antiepileptic drug (sodium valproate) to control generalised
seizures and a diuretic (torasemide) for hypertension.

Nurse:

The antibiotics for you to take home have come up from
the pharmacy and I would like to go over [discuss] what
you need to do.There are instructions on the labels, but it
helps if we talk it through [discuss] as well.

Mr A.:

Yeah [yes], OK then. I want to get it right. It was a bit
of a fright ending up in here just for a cat bite gone
septic [infected].

Nurse:

What seems like such a minor thing can quickly get
really bad.There are three separate antibiotics to
take – here look [at the containers].There are two
penicillins: flucloxacillin and phenoxymethylpenicillin.You
need to take these every 6 hours and an hour before
food or on an empty stomach.These are the best ones
for your infection and you have already told us that you
are not allergic to penicillin.The other antibiotic is
metronidazole, which you need to take every 8 hours,
but this time with or after food.

Mr A.:

Yeah, no problems with penicillin and I’m used to
taking tablets – with the Epilim [a proprietary name
for sodium valproate] twice a day and the Torem
[proprietary name for torasemide] first thing [early
morning].

Nurse:

Will there be any problem with having to take two before
food and one with or after food?

Mr A.:

No, I already need to remember to take the Epilim
after food.

Nurse:

What about writing out a chart? That would help, especially
if you cross off doses as you take them.

COMMUNICATION IN NURSING

Case history – Mr Anderson

C3996_05.qxd 26/02/2004 13:56 Page 71

Mr A.:

I don’t write so well, but one of our kids [children] can
do it.

Nurse:

It is important to take the antibiotics at regular times and
to finish the 7-day course even if your hand seems better.

Mr A.:

Why can’t I stop once it looks better?

Nurse:

Finishing the course means that the treatment will kill off
all the bugs [bacteria in this case] – the infection is cured,
and it is very important the bugs don’t become immune
[develop resistance] to the antibiotics.

Mr A.:

What like that MRSA has? OK. I’ll carry on [continue] to
the end.

Nurse:

Yes, just like MRSA, but you haven’t got that.There are a few
other things I need to tell you about the metronidazole. It
is important to swallow the tablets whole with plenty of
water. And you shouldn’t drink alcohol while you are taking
them and for 2 days after you stop – it can cause a nasty
reaction with nausea and sickness [vomiting].You might
have a furred tongue and your urine can be dark.

Mr A.:

That’s a blow [disappointment]. I could really do with a
couple of pints [meaning he would enjoy some beer].
Thanks for the warning about my pee [urine]. That
would have really put the wind up me [alarm me].

Nurse:

Have you got plenty of Epilim and Torem at home?

Mr A.:

Yeah – I never run out of tablets [have none left]. I
dread having another fit [seizure] now that they have
settled down.

Nurse:

Have you any questions or bits you don’t quite understand?

Mr A.:

It’s a lot to take in [information to absorb, understand].
Can you go through it all again please?

Nurse:

You’re right it is a lot of information. Let’s start with the
three antibiotics and when to take them ...

MOBILITY

Some nursing/medical or Standard English words and correspon-
ding colloquial words and expressions associated with mobility

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are given in Box 5.4.

Note: Colloquial expressions used in the case histories and

example conversations are explained in brackets […].

Joint stiffness and pain are causing Ms Wayne severe difficulties
with mobility. She has had rheumatoid arthritis for many years

COMMUNICATION IN NURSING

Box 5.4

Words associated with mobility (for further examples

see Ch. 6)

Nursing/medical or

Colloquial (everyday) or slang (very informal)

Standard English words

words and expressions used by patients

Akinesia

Freezing or frozen; rooted to the spot; can't go

forward

Ataxia

Staggering; jerky; shaky; all over the place

Bradykinesia

Can't get started; slowed me almost to a halt;

slowed me down nearly to a complete stop

Dorsal part of a

Knuckle

phalangeal joint,

especially the meta-

carpophalangeal joints

(with fingers flexed)

Sudden tonic muscle

Cramp

contraction

Festination

Shuffling; can't stop once I get going

Swollen

Puffed up

Swollen and deformed

Knobbly

(as an arthritic finger

joint)

Tremor

The shakes

Case history – Ms Wayne

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and now has some joint destruction and deformity with associat-
ed muscle wasting. At the moment she feels generally unwell –
very lethargic, her temperature is slightly elevated and she has
anorexia. In the past she has had surgery to her hands, which are
very badly affected.

Ms W.: Hello Nurse. Have you sorted out [organised] my

physiotherapy appointment yet?

Nurse:

Yes, the physiotherapist is coming to treat you here.What
do they usually do?

Ms W.: In the past I had heat treatment, but now they

concentrate on gentle exercise and making sure that
my hand splints are still helping and not making my
skin sore.

Nurse:

Tell me how your mobility is affected by the arthritis.

Ms W.: I have trouble [difficulties] getting in and out of bed, or

the bath, and I need help to get out of a low chair.

Nurse:

What about walking?

Ms W.: Getting about [moving about, going out] is hard. I get

around the house with the walking aid and tend to
use a wheelchair when I go out. The car has been
modified so at least I’m independent. I can go shopping
and out with my pals [friends].

Nurse:

Yes, that is important.

Ms W.: I’m not going to be an invalid [someone who is always

ill], always needing help and griping [complaining]
about the unfairness of it all.

Nurse:

How do you stay so positive?

Ms W.: After my joints, especially my hands, got really

bad [deteriorated] and I had to give up work [left
employment] I thought ‘I’m only 40 and can’t just do
nothing’. So I looked at ways I could be busy and
useful.

Nurse:

What do you do?

Ms W.: I go into the local primary school three mornings a

week and listen to the children read. It’s a great [good]
feeling when you hear them improve and become

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more confident. Just lately I started helping on a
telephone helpline for people with disabilities – there
are special hands-free phones so I don’t need to use
my hands much.

Nurse:

We [meaning Ms Wayne and the nurse] can sort out your
care plan now and make sure that we include the help you
need.You must tell me your usual routine for the hand
splints, as you’re the expert. Can you arrange for your own
wheelchair to be brought in?

Ms W.: My brother can fetch it at lunchtime if I give him a ring

[contact by telephone].

Nurse:

What about other activities? Do you have difficulty using
your hands?

Ms W.: Yes, the pain and stiffness in my hands and wrists

really hold me back [curb or inhibit]. My hands look
so awful with the finger joints all puffed up [swollen]
and it’s so frustrating and it really riles [annoys, makes
me angry] me when I can’t do something simple like
doing up [fastening] buttons. It’s always worse in the
morning when you need to wash and dress, which is
a real pain [nuisance] when I’m due at the school.

Nurse:

Are there any other movements that you find difficult?

Ms W.: Anything where I have to grip and move my wrist like

holding the kettle and pouring.

Nurse:

Again we can plan what help you will need from us while
you’re here. Do you see the OT [occupational therapist]
for help with this?

Ms W.: Yes, she has been so helpful – lots of gadgets to help

me do things, like dressing and cooking, for myself,
and so many good ideas about how to do things
without getting tired or making the pain worse.

Nurse:

Perhaps your brother can bring in the gadgets you need in
here when he comes with the wheelchair.What do you
think?

Ms W.: OK. I hadn’t thought of that.
Nurse:

The rheumatology nurse specialist will be up later to

COMMUNICATION IN NURSING

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review your drugs with Dr Wong [the rheumatologist], and
co-ordinate all the other practitioners – I expect you know
them both quite well by now.

Ms W.: Yes, I certainly do. Having Sam [Ms Wayne has known

the nurse specialist for several years and they use first
names] is a real support – he’s always there on the
phone and it’s so nice to see the same person at the
nurse-led clinics. I’m a bit disappointed about the new
drugs we tried – the benefits have definitely worn off
[become less effective].

Nurse:

Do you need anything for pain?

Ms W.: No, not at the moment thanks. I took all my morning

drugs at home and I’d rather wait to see what happens
after the drug review.

Mr Lajowski has come into the day-surgery unit to have a lipoma
removed from his back. His mobility is seriously affected by
Parkinson’s disease, which he has had for some years. He is not
particularly anxious about the surgery, as this was explained to
him at the pre-admission assessment clinic, but he is worried
about how he will cope with moving about in the new
environment.

Nurse:

Hello Mr Lajowski. I understand that you have come in
today to have a fatty lump [lipoma] removed from your
back and the plan is to send you home later this afternoon.

Mr L.:

Yes, that’s right. The lump needs to come off [be
removed] – it gets in the way of the waistband of my
trousers. I shall be glad to see the back of it [pleased
when it has gone]. Did they tell you that I have
Parkinson’s disease?

Nurse:

Yes, it’s in your notes from the assessment clinic. How does
it affect you?

Mr L.:

The walking is the worst. Its difficult to start moving
and I’m so slow [bradykinesia]. All I can do is shuffle

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Case history – Mr Lajowski

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[feet sliding, legs dragging, characteristic of Parkinson’s
disease] to start with and then my steps get shorter and
I get faster and faster [festination], can’t stop, and like
as not [likely] over I go [fall over]. I’ve really lost my
nerve [to lose confidence]. If you saw me you would
think I was the worse for drink [‘drink’ in this case
means alcoholic drink – the person is drunk, or
intoxicated, or inebriated].

Nurse:

Do you have any other movement problems?

Mr L.:

I get that freezing [akinesia] where I’m rooted to the
spot [can’t move]. It mostly comes on out of the blue
[comes unexpectedly], but I worked it out [found out,
realised] that trying to do more than one thing at once
[simultaneously] will bring it on [cause it]. The shaking
[tremor] in my hands is bad, and its hard to do some
things because my arms are so stiff [caused by rigidity].

Nurse:

What things are particularly difficult for you?

Mr L.:

It sounds daft [absurd], but it’s mainly things like
turning over in bed, reaching out for a cup, getting
up out of a chair and turning round once I’m up.

Nurse:

Are there things that help?

Mr L.:

I’ve learnt a few tricks [ways to overcome the problems],
such as having a good firm mattress and a high-backed
chair with arms. The others things are really simple,
like other people waiting until I’m ready to move and
giving me time to do things for myself. When I freeze,
the physio’ [physiotherapist] told me to try stepping
over an imaginary line, or to count ‘one–two’ out loud
with each step and that does help.

Nurse:

What about other activities, such as those needing fine
movements?

Mr L.:

Doing up [fastening] shoelaces or buttons is impossible,
so that material that sticks to itself is very handy
[helpful, useful]. What’s it called again?

Nurse:

Oh, you mean Velcro. It’s very useful, we use it a lot in the
rehab. [rehabilitation] unit.

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Mr L.:

I get loads [a lot] of cramp [sudden tonic muscle
contraction] attacks at night, so I’m awake half the
night [disturbed sleep]. Before the Parkinson’s I could
just pop out [get out] of bed and it would go.

Nurse:

Not so easy now.

Mr L.:

How right you are. I wish it would settle down
[become quiescent].

Nurse:

I gather [understand] that your medication has just
[recently] been changed.

Mr L.:

Yes, I said to the Doc [short for doctor] that the cramp
had gone on [continued] too long and he said that I
could try some different tablets.

Nurse:

Any luck with the new tablets [meaning are they
effective]?

Mr L.:

Early days [too soon to be sure], but I think the cramps
have eased off [become less frequent].

EATING AND DRINKING

Some nursing/medical or Standard English words and correspon-
ding colloquial words and expressions associated with eating and
drinking are given in Box 5.5.

Note: Colloquial expressions used in the case histories and

example conversations are explained in brackets […].

Miss Hyde-Whyte has come into the community hospital for
assessment. She lives alone and has been retired for over 20 years.
The district nursing team, who have been visiting Miss Hyde-
Whyte to treat her leg ulcer, have recently become concerned
about her lack of interest in meals and obvious weight loss.

Nurse:

Hello Miss Hyde-Whyte, I’m Nurse Mosquera. I would like
to ask you some questions.Will that be all right?

Miss H.: Hello – please call me Maggie. The rest is such a

mouthful [difficult to say].

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Case history – Miss Hyde-Whyte

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Nurse:

I will need to weigh you and measure your height, but first
a few questions.

Miss H.: I’m sure that I have lost weight – all my clothes hang

on me [are much too big].

Nurse:

How often do you eat and drink?

Miss H.: Well I used to have breakfast, a proper cooked lunch

and something on toast or a sandwich in the evening.

Nurse:

Has something changed?

Miss H.: I used to really enjoy cooking, have a G&T [gin and

tonic] and then sit at the table with a nice meal, but

COMMUNICATION IN NURSING

Box 5.5

Words associated with eating and drinking (for further

examples see Ch. 6)

Nursing/medical or

Colloquial (everyday) or slang (very informal)

Standard English words

words and expressions used by patients

Abdomen

Belly; gut; stomach; tummy

Abdominal pain

Belly ache; gut rot; stomach/tummy ache

Anorexia

No appetite

Dyspepsia

Acid indigestion; heartburn

Good appetite

Always hungry; eat like a horse; ready for my

grub

Halitosis

Bad breath; mouth odour

Nausea

Biliousness; feel sick; queasiness

Oesophagus

Gullet

Poor appetite

Can't face food; don't eat enough to keep a

bird alive; been off my food; not hungry; peck

or pick at food

Stomatitis

Mouth ulcers; sore mouth

Vomit

Be sick; bring up; lose the lot; puke; retch; sick

up; spew; throw up

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now I’ve got no appetite and I just pick at it [the food].
My dad [father] would have said you don’t eat enough
to keep a bird alive [have a poor appetite].

Nurse:

Why do you think your appetite has decreased?

Miss H.: Two reasons I think. I’ve had mouth ulcers for ages [a

long time]. Probably my false teeth [dentures] don’t fit
anymore; and I have been sick [vomited] a few times
after meals.

Nurse:

I’ll look at your mouth in a moment [in a short time] and
see if any treatment would help. It might be a good idea to
see your dentist about the poorly fitting dentures.Tell me
about the vomiting.

Miss H.: If I eat a proper meal I soon feel sick [nauseated] and

then I’m sick [vomit]. The food just comes back.

Nurse:

Are you sick at any other time?

Miss H.: No, only after food.
Nurse:

What colour is the vomit? Is there any blood or bile?

Miss H.: No blood and it’s not green or yellow like bile. The

colour varies – it depends on what I’ve eaten.

Nurse:

Sometimes blood can look like coffee grounds [describes
the appearance of partially digested blood in the
vomit] – anything like that?

Miss H.: No, nothing like that.
Nurse:

How do you feel afterwards?

Miss H.: That’s the strange thing. Once I’ve been sick I feel fine

[all right]. My stomach [abdomen] feels uncomfortable
before I’m sick, but that feeling soon goes afterwards.

Nurse:

When you were eating normally what sort of food did
you cook?

Miss H.: Proper meals – meat or fish and lots of veg. [short for

‘vegetables’] and I always had dessert or some cheese.
No point doing all that if you’re going to be sick.

Nurse:

How often do you usually shop for food?

Miss H.: Most days. It’s nice to get out and have a chat [talk]

with people.

Nurse:

What do you eat and drink now?

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Miss H.: I know that I must eat something, so I have things

like scrambled [a cooking method] egg on toast,
soup and milky drinks. It’s not unpleasant [In English
when you have two negatives, known as a ‘double
negative’, it creates a middle way, meaning ‘not a
positive’ (‘a pleasant diet’) but not a negative (‘an
unpleasant diet’) either. So here, ‘not unpleasant’ means
a fairly acceptable diet], but I know it’s not enough.

Nurse:

Let’s see how much you weigh.What’s your normal weight?

Miss H.: Before the vomiting started I had been about 10 stone

[an Imperial Unit of weight where 1 stone = 14 pounds,
see Ch. 11] for as long as I can remember [for a long
time].

Nurse:

We use the kilogram for weight, but I can tell what it is in
stones and pounds.

Miss H.: What’s the verdict [finding] then. Have I lost much?
Nurse:

I’m afraid [The phrase ‘I’m afraid’, is used to introduce news
which is unwelcome or bad] you have lost about 11 kilo-
grams.You weigh 52 kilograms; that’s 8 stone 2 pounds, so
that’s nearly 2 stone less than usual.We will have to keep
an eye on [keep a frequent check] your weight.

Miss H.: Well, it’s no surprise my clothes are much too big.
Nurse:

I’m going to refer you to the dietician and ask her to come
and do a full nutritional assessment and see how we can
provide you with enough nutrients and fluid while we wait
for all the tests [investigations] to be done. Meanwhile, we
can order things like scrambled eggs, and give you soup and
drinks with added nutrients [fortified] if you’re sure that
won’t make you sick.

Miss H.: I’m sure that will be fine, thank you.

Mr Wakefield is a farmer. His son Tom also works on the farm
and lives with his wife and two children in the main farmhouse.
Mr Wakefield moved to a smaller house on the farm when his

COMMUNICATION IN NURSING

Case history – Mr Wakefield

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wife died about 6 months ago. The last 6 months have been very
difficult for Mr Wakefield, and he has come into the health cen-
tre to see the practice nurse about feeling generally unwell.

Nurse:

Hello Mr Wakefield. How are you today?

Mr W.: Not up to much [a term used to describe feeling

generally unwell or having a low mood]. You
know – it’s hard to feel interested in anything
these days.

Nurse:

Yes, it must be about 6 months since your wife died.

Mr W.: It will be exactly 6 months on Wednesday. Her dying

like that really hit me for six [dealt a severe blow or
disappointment]. Tom does his best, but I miss her so
much. I can’t keep on like this [can’t continue in this
condition].

Nurse:

What do you mean?

Mr W.: I can’t leave Tom to run [manage] everything, but I

feel dreadful [an emotional phrase to express feeling
very unwell].

Nurse:

In what way do you feel unwell?

Mr W.: Most of it’s my own fault. I know it’s bad for me.
Nurse:

Bad for you?

Mr W.: The evenings are so long without her [his wife] and at

first I thought a couple of drinks [meaning alcoholic
drinks] would help me unwind [relax] and get through
until bedtime.

Nurse:

Did it help?

Mr W.: Not really and I ended up having more than a couple

of drinks.

Nurse:

Many more?

Mr W.: Oh yes, most evenings I manage a bottle of wine and

some whisky, and then regret it in the morning.

Nurse:

How do you feel in the morning?

Mr W.: Headache and generally lousy [unwell]. I can’t face

breakfast and I’m often sick [vomit].

Nurse:

Do you take anything for the headache?

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Mr W.: A couple of aspirin, but they give me terrible [severe]

indigestion.

Nurse:

You have obviously been thinking about the amount of
alcohol you drink.

Mr W.: Yes, it’s worrying me. What if I can’t stop and become

an alcoholic or something?

Nurse:

How much do you think you’re having in a week?

Mr W.: I know that there are sensible limits in units, but I

don’t know what they are.

Nurse:

Most men can safely drink 3–4 units a day without a
significant risk. A unit is 10 grams of alcohol and this is
half a pint [an Imperial measure, see Ch. 11] of standard
strength beer or one glass of wine or one pub measure of
spirits. Some stronger wines have more than 1 unit.The
recommended level is 21–28 units for a man spread over
1 week. It’s best to avoid binge drinking [uncontrolled
drinking] and keep 1 or 2 days when you don’t drink.

Mr W.: My intake is well over the sensible limit. Most nights I

probably have over 10 units. I need to do something
about it.

Nurse:

You seem to have made up your mind to reduce your
intake of alcohol. Have you thought about how you might
do this?

Mr W.: I don’t want to give up [stop] drinking completely. In

the past I enjoyed a drink in moderation and that’s
what I want to aim for. Some people say that they
never touch a drop [in this case never drink alcohol],
but that’s not for me.

Nurse:

It’s good to have a realistic goal, and drinking in moderation
may have health benefits, such as reducing heart disease.

Mr W.: All this booze [slang for alcohol] has made me put on

weight [weight increased], so it will be healthier if I cut
down [reduce] on drinking and lose weight.

Nurse:

Are evenings the only time that you have a drink?

Mr W.: Yes, when I’m on my own [alone].
Nurse:

What can you do to change the pattern?

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Mr W.: I used to enjoy a walk round the farm of an evening

and my grandsons keep badgering [pestering] me to
take them out.

Nurse:

Do you think that’s possible?

Mr W.: Yes, and I think it would help.
Nurse:

I would like to see how you get on [check on your
progress]. Perhaps we can make another appointment,
and while you’re here we can make you an appointment
with Doctor Welch. She can arrange for support from a
counsellor, and she might think that you would benefit
from some medication.

Mr W.: Yes, I know I need some proper help and it’s such a

relief to have told someone about my drinking. I could
never tell Tom. It would cause too much bother [upset].

ELIMINATION

Some nursing/medical or Standard English words and correspon-
ding colloquial words and expressions associated with elimina-
tion are given in Box 5.6.

Note: Colloquial expressions used in the case histories and

example conversations are explained in brackets […].

Mrs Carter has been admitted to the coronary care unit for treat-
ment of unstable angina. She has had angina for about 2 years.
During a conversation about the need to use a commode by the
bed in order to reduce exertion and hence the oxygen needed by
the heart muscle [myocardium], she tells you that she has trouble
with her waterworks [urinary tract, especially the bladder].

Nurse:

What sort of problem with your waterworks?

Mrs C.: I can’t hold on and I leak urine [incontinent of urine].

It’s so embarrassing.

Nurse:

It sounds like you have two separate problems.

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

Case history – Mrs Carter

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Mrs C.: I hadn’t thought of it as two problems, but it does

happen at different times. The main problem is the
need to pass water [micturate] so often and when I need
the toilet [lavatory] it is all of a rush [urgent]. Sometimes
I don’t make it in time and wet myself [incontinent of

COMMUNICATION IN NURSING

Box 5.6

Words associated with elimination (for further

examples see Ch. 6)

Nursing/medical or

Colloquial (everyday) or slang (very informal)

Standard English words

words and expressions used by patients

Constipation

Bunged up; clogged up; costive; haven't been for

days; not going properly

Defaecate

Go to the toilet; have bowels open; do number

two; pass a motion or stool; to do one's

business; to have a clear out

Diarrhoea

Gippy tummy; loose motion; runs; squitters; to

be taken short; trots

Faeces; stool

Business; motion; number two; pooh

Flatulence

Belching; feel bloated; gas; wind

Incontinence

Have an accident; I leak; leaky; messed myself;

not able to hold on; wet myself

Micturition/urinate

Number one; go to the loo/toilet; pass water;

pass urine, pee; spend a penny; tiddle; wee or

wee-wee

Lavatory

Bathroom; bog; cloakroom; convenience; gents';

ladies'; latrine; lav.; little girls' room; loo; privy;

smallest room; toilet; washroom; water closet

(WC)

Urine

Pee; water

Urinary tract

Waterworks (especially the bladder)

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urine]. The leaking happens when I cough or laugh.

Nurse:

How often do you pass water [micturate]?

Mrs C.: Every couple [two] of hours or so [approximately]

during the day.

Nurse:

What about at night, do you have to get up in the night
[to pass water]?

Mrs C.: Oh yes, I have to keep getting up [frequently get out of

bed to urinate]. Always twice a night and sometimes
more often.

Nurse:

When did you start having problems?

Mrs C.: Just after I retired. I’m 68 now, so it must be about

4 years ago.

Nurse:

Have you told your GP or the practice nurse?

Mrs C.: I felt too embarrassed and it’s something that happens

when you get older isn’t it? It really limits my social life
and it worries me that I might smell.

Nurse:

It is more common in older people, but there are different
causes and many can be successfully treated. How do you
normally cope with the problem?

Mrs C.: I try to be near a toilet, but that’s not always easy if

I’m out. There are not many public toilets and some
of them are not very clean. I wear a sanitary towel
[normally used during menstruation] in my knickers
[pants, underwear] to cope with the leaks, but I still
have plenty of washing to do [implying that this does
not always work].

Nurse:

I will add all this to your care plan and make sure that
everyone knows to bring the commode as soon as you ask.
Would you like a supply of towels and disposal bags to
keep in the locker?

Mrs C.: Yes please.
Nurse:

When your angina has settled down and you are feeling
better I will arrange for the continence nurse specialist
to come to see you. She is the expert and will be able
to do a full assessment and suggest ways of improving
the situation.

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Mrs C.: I wish I’d told someone earlier, but I thought that you

had to grin and bear it [put up with it]. I had no idea
that anything could be done.

Nurse:

While we’re waiting I’d like to have a specimen [sample] of
your water to test, and if that shows that you might have
an infection we can collect a midstream specimen of urine
for the laboratory.

Mrs C.: Is that the test where you have to pee [micturate] into

a pot?

Nurse:

Yes, that’s the one, but we only need the middle bit of the
flow, not the urine that comes out first. Have you noticed
any blood in your urine or an unusual smell?

Mrs C.: No, nothing like that.
Nurse:

What about pain when you pass urine? Does it burn or
sting?

Mrs C.: No, I had cystitis when I was younger and I know how

painful it is when you go [when she passes urine;
micturates].

Nurse:

We also need to know how often you are passing urine
and how much fluid you are having, but as we are already
recording fluid balance for you we will have that
information.

Mrs C.: You will tell the nurses about how urgent it is when I

ask for the commode?

Nurse:

Don’t worry I’m putting it on the care plan now, and I will
tell the nurse who takes over from me tonight. Do you
think you could give me that sample now?

Mrs C.: Yes.
Nurse:

Have you any questions before I go and get the commode?

Mrs C.: No, I’m looking forward to feeling better and seeing

the specialist nurse about the waterworks.

Mr Norton fractured his femur in a motorcycle accident 2 weeks
ago. The fracture is being managed with skeletal traction and

COMMUNICATION IN NURSING

Case history – Mr Norton

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Mr Norton has accepted that he will be much less active than
usual and will be in hospital for some weeks. He had started to
feel better after the accident and the pain in his leg was gradual-
ly subsiding, but now he feels bloated [blown up, distended],
lethargic and has no appetite.

Mr N.:

I feel terrible [very bad], really out of sorts [unwell].

Nurse:

What’s the trouble?

Mr N.:

I haven’t been properly for days [has not defaecated
properly for days and is constipated].

Nurse:

When did you last have your bowels open [defaecate]?

Mr N.:

Saturday was OK, so that’s 4 days ago. I wish I’d said
earlier, but it seemed stupid to be worried about not
going [defaecating] when I’m laid-up [confined to bed]
with a leg that’s broke [fractured].

Nurse:

How often do you usually go?

Mr N.:

Every day without fail.

Nurse:

It’s probably happened because you’re not as active as usual
and having to use a bedpan doesn’t help.

Mr N.:

Well I can’t do much with the traction and stuff.

Nurse:

How is it making you feel?

Mr N.:

I’m all blown up and full of wind [flatulence]. Look at
my stomach [abdomen], it’s huge. I couldn’t eat nothing
and my mum [mother] had brought in a Chinese [a
takeaway meal] as a treat.

Nurse:

Yes, your abdomen is a bit distended. Have you any pain?

Mr N.:

A bit. It feels like colic [usually refers to intermittent
abdominal pain, most often from the intestine, but
sometimes from other structures].

Nurse:

What was your motion [faeces; stool] like on Saturday?

Mr N.:

Just a few hard bits and I had to strain [push hard] to
get that out.

Nurse:

What it’s like normally?

Mr N.:

Normal – soft and not having to strain. Except when
I’ve got the runs [diarrhoea] after too much beer and
a curry.

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Nurse:

Was there any pain passing the hard motion, or blood
when you cleaned yourself?

Mr N.:

No pain and I didn’t see no blood. If I had I would
have said straight away [immediately, at once].

Nurse:

Did you feel that you hadn’t passed a complete motion?

Mr N.:

Yeah [yes], my back passage [rectum] felt full just as if
there was more to come.

Nurse:

I’ll get Dr Cox to write you up for [prescribe] some
medicine [laxative] to make you go and we can ask the
physio. [short for ‘physiotherapist’] to suggest some
exercises to help.

Mr N.:

My gran [grandmother] swears by [relies on] her bottle
of bowel medicine.

Nurse:

You might need some suppositories or a micro enema to
get things started and then a few doses of an oral laxative.
Hopefully you won’t need a whole bottle. It will also help if
you can drink more water and choose food high in fibre
from the menu.

Mr N.:

Yeah alright, but I don’t want salad every meal.

PERSONAL CARE – CLEANSING AND DRESSING,
SKIN CARE

Some nursing/medical or Standard English words and correspon-
ding colloquial words and expressions associated with personal
care are given in Box 5.7.

Note: Colloquial expressions used in the case histories and

example conversations are explained in brackets […].

Mrs McBride lives alone, and Sue her daughter-in-law [the wife of
Mrs McBride’s son] pops in [visits] most days to take her a meal
and check that she is all right. Recently, Sue has noticed that Mrs
McBride is increasingly frail and takes a long time to answer the
door or make a drink.

COMMUNICATION IN NURSING

Case history – Mrs McBride

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Nurse:

Hello Mrs McBride. I’m Nurse Ramos. I think you are
expecting me. I’ve come in to see how you are managing
at home.

Mrs M.: Hello dear [an endearment often used by older people]

come in. Yes, I knew you were coming. Sue mentioned
it earlier when she was in with my lunch [meal in the
middle of the day]. She’s a good girl to me.

Nurse:

I’ve got a checklist to complete, but it’s usually better if
you tell me in your own words how you think you are
managing.What about if we start with any difficulties you
might be having with washing and dressing?

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

Box 5.7

Words associated with personal care (for further

examples see Ch. 6)

Nursing/medical or

Colloquial (everyday) or slang (very informal)

Standard English words

words and expressions used by patients

Bath/bathe

Have a soak; scrub down

Contusion

Bruise

Dandruff

Scurf

Emollient

Moisturiser

Erythema

Redness

Excoriation

Soreness

Halitosis

Bad breath; mouth odour

Oral hygiene

Brush/clean teeth; mouth wash

Pressure ulcer

Bedsore; pressure sore

Pruritus

Itching (intense)

Rash

Spots/spotty

Wash

Hair wash; hands and face wash; strip wash;

wash at the sink/basin

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Mrs M.: Yes, that’s fine. I’ve always been as fit as a fiddle [in

very good health], but since the winter it’s got more
and more difficult. Well I am 83. It’s all down to [as a
result of] old age I suppose.

Nurse:

What’s more difficult?

Mrs M.: I struggle a bit with a strip wash [wash all over] at the

sink, but I get by [cope]. My feet and back don’t get
done, and it’s hard to stand up to wash down below
[genital and perianal area]. I need to hold on to the
sink and then I can’t soap the flannel.

Nurse:

Are you able to have a bath or shower?

Mrs M.: No, I’m not strong enough to get in and out of the

bath. I’m frightened of slipping, or getting in and not
getting out again.

Nurse:

How often did you have a bath when you were able to
manage?

Mrs M.: Two or three times a week. Heating the water with

the immersion heater costs too much to have a bath
every day.

Nurse:

How do you heat the water for your strip wash?

Mrs M.: Boil a kettle; I’ve got one in the bedroom for a cuppa

[usually refers to a cup of tea] in the morning. Would
you like a cup of tea now?

Nurse:

No thanks I had one [cup of tea] just before I came out to
see you.Would you like to have a bath if it was possible?

Mrs M.: Oh yes, there’s nothing like a soak in the bath for

getting clean and relaxing you.

Nurse:

I quite agree. Is there anyone who could help you?

Mrs M.: I can’t ask Sue. She has three children to get off to

school, and I don’t want to sit in my dressing gown
until she can get here.

Nurse:

Would you consider having a bath seat that lowers you into
the bath and then goes up when you’re ready to get out?

Mrs M.: I’m hopeless with machines. How easy are they to use?
Nurse:

Very easy.You have a button to push that lowers and raises
the seat. If you like we can arrange for someone from

COMMUNICATION IN NURSING

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Social Services to come out and do an assessment.What
about washing your hair?

Mrs M.: That’s no problem. I can do it at the sink. My

neighbour used to be a hairdresser and she comes
in every few weeks and gives it a cut and set.

Nurse:

That’s handy [convenient].

Mrs M.: It certainly is. I can’t get down the town these days

unless Sue takes me. I haven’t been shopping on my
own for ages [for a long time].

Nurse:

Do you have any problems getting dressed and undressed?

Mrs M.: Some things take for ever [a long time], like putting on

tights or trousers.

Nurse:

What about doing things up – buttons and zips, etc.?

Mrs M.: I make sure that clothes do up at the front – no good

struggling with a zip at the back of a dress.

Nurse:

The occupational therapist can suggest some simple
gadgets [appliances, devices] to help with dressing and
show you about easier ways of doing things.Would you
like me to arrange for her to come?

Mrs M.: Yes please. Another neighbour, Mrs Smith at number 80

[the house number], had a visit from one of them and
she got on very well.

Mr Dafnis is going to have planned [elective] surgery. He has a
long history of eczema, with dry, itchy skin. When he attends the
pre-admission assessment clinic he expresses some concern
about the care of his skin condition while he is in the ward after
the major surgical operation.

Mr D.:

I’m worried about my eczema when I come into
hospital. It’s important to follow my usual routine or
it will flare up [get worse] again.

Nurse:

How long have you had eczema?

Mr D.:

For years, it’s chronic now but some things make it
worse.

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Case history – Mr Dafnis

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Nurse:

What sort of things?

Mr D.:

In my case it’s things like getting too hot, such as from
the sun shining through a window.

Nurse:

We can arrange for you to have a bed well away from any
windows. Is there anything else?

Mr D.:

Alcohol starts up the itching [pruritus], but I never
touch it [does not drink alcohol] nowadays.

Nurse:

What’s your skin like now?

Mr D.:

Not very good. It’s very red [erythema] and the itching
and scratching is much worse. I put it down to [caused
by] the stress of having to have the op. [short for
‘operation’].

Nurse:

Which areas are worse affected?

Mr D.:

Mainly my face, as you can see, and my back is
very itchy.

Nurse:

Have you any sore areas [excoriation] or weeping
[producing exudate] areas?

Mr D.:

No, my skin is just dry and very itchy. Any vesicles
and broken areas would mean I was open to infection.
Is that why you’re asking?

Nurse:

Yes, exactly. But to be on the safe side I’ll get the doctor to
have a look now.What measures are you taking to reduce
the flare up?

Mr D.:

I never use soap because it takes out my natural skin
oils, so I use soap substitute, and at the moment I’m
using an oily moisturiser [emollient] nearly every hour,
but touch wood [a reference to the habit of touching
something wooden to avert bad luck] it won’t be so
bad by the time I come into the ward.

Nurse:

Are you using anything other than the emollient on your skin?

Mr D.:

No.

Nurse:

Have you used steroid ointments lately?

Mr D.:

No, not for months. I only have them as a last resort.

Nurse:

What about other medicines?

Mr D.:

I’m taking an antihistamine so the scratching is reduced
and I can get some sleep.

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Nurse:

I’ll make sure that your skin management is written in the
care plan. Have you any questions?

Mr D.:

What if my eczema gets really bad before I’m due to
come in?

Nurse:

If it gets any worse please let us know. I’ll be giving you
some printed information with the unit telephone number
in any case.

Mr D.:

OK, thanks.

SLEEPING

Some nursing/medical or Standard English words and correspon-
ding colloquial words and expressions associated with sleeping
are given in Box 5.8.

Note: Colloquial expressions used in the case histories and

example conversations are explained in brackets […].

Mrs Bell moved into the care home from sheltered housing [hous-
ing with communal areas and a warden] 5 days ago. She had
enjoyed her time there, but after the fall and the fractured hip she
felt that she needed more care. Although there was a button to
press to get help, she was frightened of falling again and having
to wait for help to come. Both her sons were concerned about
her and going into the home seemed the most sensible thing to
do. She hadn’t expected to feel at home straight away, but she is
missing her friends and is not sleeping well.

Nurse:

Good morning Mrs Bell how are you settling in?

Mrs B.: Not too bad I suppose, but it feels a bit strange still.
Nurse:

I thought it would be helpful for us to have a chat now
that you have been here for a few days.You said that it
feels strange.

Mrs B.: I’m not complaining and everyone is so kind, but I

miss the ladies from the sheltered housing.

Nurse:

Have any of them visited you yet?

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Case history – Mrs Bell

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Mrs B.: The warden came yesterday and it was nice to hear all

the gossip. My special friends are away on their hols
[holiday] until next week, so I expect they will be
round then.

Nurse:

That’s good.What about your sons?

Mrs B.: John brought me in, and he came yesterday on his way

home from work. Nigel works away during the week,
but he will be in on Saturday.

Nurse:

Have you got to know the other residents yet?

Mrs B.: I had tea [a light meal in the afternoon or evening]

with Mrs Forbes and she was very friendly.

Nurse:

How are you sleeping?

Mrs B.: Not very well, I’m awake half the night.

COMMUNICATION IN NURSING

Box 5.8

Words associated with sleeping (for further examples

see Ch. 6)

Nursing/medical or

Colloquial (everyday) or slang (very informal)

Standard English words

words and expressions used by patients

Bruxism

Grind my teeth during sleep

Go to bed/sleep

Hit the hay/sack; retire for the night;

say goodnight; turn in

Insomnia

Awake half the night; can't get off (to sleep);

sleeplessness; wakefulness; wide awake

Narcolepsy

Drop off without warning

Sleep

Catnap; doze/dozing off; drop off; forty winks;

kip; lose myself; nap; siesta; shut eye; snooze

Sleep hygiene

Bed time or pre-sleep routine/rituals

Somnambulance

Sleep walking

Somnolent

Dozy; drowsy; heavy-eyed; nodding off; sleepy

Weary

Dead beat; dog-tired; done in; ready to drop;

whacked

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Nurse:

Is that usual for you?

Mrs B.: Not really. I used to have the odd [in this context

means ‘infrequent’ or ‘unusual’] night when I would
wake up, but most nights I would sleep right through
until about half past six [6.30 a.m.].

Nurse:

Do you have trouble falling asleep [going to sleep] or do
you wake up in the night?

Mrs B.: I’m really tired, but as soon as I put the light out I’m

wide awake again.

Nurse:

Do you get to sleep eventually?

Mrs B.: Yes, but then I wake up feeling whacked [weary] and

groggy [unwell]. I don’t feel rested.

Nurse:

Do you wake up earlier than usual?

Mrs B.: I did this morning. There was a lot of coming and

going [activity] because the lady in the next room was
poorly [unwell].

Nurse:

Yes, she had to go into hospital.

Mrs B.: And I’m so tired in the day I keep dozing off [going to

sleep] in the chair.

Nurse:

Did you usually have a short nap [sleep] during the day
before you came to us?

Mrs B.: Well, if I’m honest, I did sometimes put my feet up

[relax] after the lunchtime Archers [a long-running
radio programme] and lose myself for a bit [have a
short sleep].

Nurse:

What time have you been falling asleep in the chair?

Mrs B.: After supper [last meal of the day], so when I come to

[wake up] it’s time to start thinking about going to bed.
That’s a bit late for a nap I know.

Nurse:

Do you have a bedtime routine – things that help you get
to sleep?

Mrs B.: I used to have a bath last thing [just before going to

bed] and take a milky drink to bed. Then read until I
felt drowsy [somnolent].

Nurse:

What sort of time [approximate timing] would you usually
have the bath?

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Mrs B.: After the news at ten [10 p.m.] and be in bed by 11

[11 p.m.]. I’m not sure if it’s all right to have a bath that
late here. I expect the girls [night staff] are too busy to
help with baths.

Nurse:

I will have a word [discuss it] with the nurse in charge
tonight about making sure you can have a bath if you want,
and get a milky drink. It is so important to get a good
night’s sleep.

Mrs B.: You can say that again [emphasises the importance of

the nurse’s last statement]. I would be very grateful if
they could help me with a bath.

Nurse:

Is there anything else that can be done to help you sleep
properly?

Mrs B.: It is quite warm in my room. I’m not used to having

the radiator so hot in the bedroom.

Nurse:

We can turn the thermostat down, so it just takes the chill
off the room [make sure that the room is not cold].

Mrs B.: They tried last night, but it was too stiff to turn.
Nurse:

I’ll get on to [contact] the maintenance staff right away
[at once].

Mrs B.: It was so hot I pushed the duvet off me. I haven’t done

that since the change [climacteric/menopause] when I
used to have night sweats.

Nurse:

What about when you get up in the morning, will you be
warm enough?

Mrs B.: Oh yes, my boys [her sons] treated me to [paid for]

some new clothes to come in here and that included
a fleecy dressing gown. Look it’s on the chair. Do you
think it’s too bright?

Nurse:

I like that dark pink. It’s such a warm colour.

Mrs B.: Yes, I like it. I did wonder about pink at my age, but

then I thought ‘Why not?’.

Nurse:

Is there anything else that stops you sleeping?

Mrs B.: I still need to get used to [become accustomed to] the

light coming in from the corridor.

Nurse:

Were you used to sleeping in complete darkness?

COMMUNICATION IN NURSING

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Mrs B.: Yes, the sheltered housing is on the edge of the village,

right out in the sticks [rural location, in the
countryside].

Nurse:

We need to keep the light on in the corridor, so that
everyone can move about safely.

Mrs B.: Yes, I know. I don’t suppose it will bother [trouble] me

for long.

WORKING AND PLAYING

Some nursing/medical or Standard English words and correspon-
ding colloquial words and expressions associated with working
and playing are given in Box 5.9.

Note: Colloquial expressions used in the case histories and

example conversations are explained in brackets […].

Mr Khan is about to be discharged home after having a myocar-
dial infarction a week ago. He normally helps to run the family
business and needs to drive all over the UK to see customers. He
is anxious about how a recent myocardial infarction will affect his
driving, the business and his leisure activities.

Mr K.:

Nurse Brown, have you got a minute [the time] to talk?

Nurse:

I need to give a painkiller to another patient. I’ll be back in
5 minutes.

Mr K.:

OK.

Nurse:

Right, Mr Khan I’m back.What would you like to talk about?

Mr K.:

I’m really worried about how I’ll manage to run my
part of the business after the heart attack [myocardial
infarction].

Nurse:

Did you speak to the cardiac nurse specialist?

Mr K.:

Yes, on Tuesday. She explained everything and I asked
lots of questions. It all seemed quite straightforward
[easy, simple], but now that I’m dressed and ready to
go home I’m not so sure.

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

Case history – Mr Khan

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Nurse:

Did she leave the printed information?

Mr K.:

Yes.

Nurse:

What bits are worrying you?

Mr K.:

Well, mainly the driving and getting back to work. I
drive about 20 000 miles a year on business. There is
something in the leaflet about driving, but I’m worried
that Swansea [the location of the Driver and Vehicle

COMMUNICATION IN NURSING

Box 5.9

Words associated with working and playing (for fur-

ther examples see Ch. 6)

Nursing/medical or

Colloquial (everyday) or slang (very informal)

Standard English words

words and expressions used by patients

Dismissed

Fired; given my cards; given the boot; given my

notice; given the push; got the sack; laid off; let

go; marching orders; sacked; sent packing

Employed

Hired; in a job; in work; paid work; working

Employee

Bread-winner; wage-earner; worker

Employer

Boss; gaffer; governor

Leisure/leisure activities

Amusement; breathing space; free time; fun;

hobby; pastime; play; pleasure; recreation; R&R;

spare time; time off

Occupation; profession

Business; career; calling (outdated); craft; job;

line of work; livelihood; position; trade; walk of

life; work

Relaxation

Chill out; laze about; let one's hair down;

loosen up; put one's feet up; take it easy; unwind

Retired

Given up work; pensioner; pensioned off;

put out to grass

Self-employed

Freelance; my own boss; work for myself

Unemployed

Jobless; looking for a job/work; not working; on

the dole/social; out of work

C3996_05.qxd 26/02/2004 13:56 Page 99

Licensing Agency (DVLA); the word ‘Swansea’ may be
used to describe it in conversation] will take my
licence away.

Nurse:

Is yours an ordinary licence?

Mr K.:

I should think so.

Nurse:

You don’t drive a bus or a lorry do you?

Mr K.:

No, just the car and sometimes the minibus for the
Community Centre.

Nurse:

You will need to stop driving for at least 4 weeks and you
don’t have to notify DVLA.You have an appointment to see
Dr Bradley [the cardiologist] next month. He will advise
you about when you can start driving again.

Mr K.:

I hope it’s not much longer than 4 weeks. My dad
[father] and brother can visit the customers for a few
weeks, but not for ever.

Nurse:

So far your recovery has gone well.There’s no reason to
think you won’t be fit [well enough] to drive in a month. It
might be a good idea to tell your insurance company about
the heart attack.

Mr K.:

Yes, that’s sensible. I don’t want to drive without
insurance. That means a fine and six points on your
licence.

Nurse:

You mentioned getting back to work.

Mr K.:

We run a small family business, so one person off sick
puts a real strain on everyone else.

Nurse:

Yes, I can see that. Do you do most of the customer
visiting?

Mr K.:

Yes, my dad doesn’t really like driving long distances
and my brother is better at the day-to-day business.

Nurse:

Again Dr Bradley will advise you about going back to work,
but most people gradually increase their activity and are
back at work in 4–6 weeks. It would be longer if you had a
job with a lot of physical activity.

Mr K.:

No, if I’m in the office it’s mainly computer work and
telephoning customers. My job isn’t very active, but I’m
keen on sport.

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

100

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Nurse:

What sport do you do?

Mr K.:

I play some cricket and coach some lads [boys,
youngsters] in a local football team.

Nurse:

How active is the coaching?

Mr K.:

Well I work-out [train] with the boys. I’m keen to keep
on [continue] with both the cricket and the coaching.

Nurse:

The staff running [organising] the formal sessions of the
cardiac rehabilitation programme will be able to give you
information about safe levels of exercise and playing sport.
When do you start?

Mr K.:

The specialist nurse said that she will give me a ring
[telephone] next week to see how we’re getting on
[coping] at home and by then she will know the dates
for the exercise sessions.

Nurse:

Don’t forget the cardiac nurses have a telephone helpline if
you have any worries once you get home, and you can also
use their e-mail.

Mr K.:

Yes, it’s very reassuring to know that there is some
back-up [support].

Nurse:

Have you any questions about your drugs and the dietary
changes, or anything else?

Mr K.:

No, that’s all the worries for now. I just needed to get
those things straight [sorted] in my mind.

Mrs Hamilton has had diabetes for many years and her vision is
deteriorating due to diabetic retinopathy. She and her husband
are both retired and enjoy walking and gardening.

Nurse:

Hello Mrs Hamilton. It doesn’t seem like a year since we
last saw you.

Mrs H.: Yes, time for the annual eye check again.
Nurse:

Not everyone is so reliable about attending as you.

Mrs H.: I’d be daft [foolish, unwise] not to. Finding problems

early is so important. My sight is already bad, I don’t
want it to get any worse.

COMMUNICATION IN NURSING

101

Case history – Mrs Hamilton

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Nurse:

I will be putting the eye drops in to dilate your pupil, so we
can examine the back of your eye [retina]. How has your
sight been since last year’s check?

Mrs H.: I’m finding it more difficult to read small print and

I’ve got patchy [uneven] blurring of vision. It does
make life difficult.

Nurse:

How does it affect you on a day-to-day basis?

Mrs H.: Now Jim [her husband] and I have given up working

[retired] we have time to do our garden. I have always
had green fingers [keen gardener] and we like walking
in the countryside, but it’s not much fun with my poor
vision. I have to rely on Jim to read the labels on weed
killer for the garden and the plant labels at the garden
centre. He doesn’t mind, but I mind very much. I feel
so helpless and frustrated about losing my
independence.

Nurse:

Yes, it must be frustrating.

Mrs H.: I’m really cheesed off [fed up]. It’s reading books as

well. I like to relax with a book after supper [last meal
of the day] while Jim has a pint [in this context it
means beer] at our local [nearest public house]. But
now I can only see if the print is very large and every
light in the room is on. It’s not very relaxing.

Nurse:

No, it doesn’t sound very relaxing. Have you got any low
vision aids?

Mrs H.: I’ve got my glasses [spectacles] and a magnifier and I

make sure that the lighting is right for what I’m doing.

Nurse:

How is your diabetic control?

Mrs H.: OK. I’m doing quite well with the sugar control and the

insulin injections are no problem now I use a preloaded
insulin pen [device for injecting insulin].

Nurse:

I’m sure you know how important this is to help stop the
retinopathy from getting worse.

Mrs H.: Oh yes, the diabetic nurse specialists are always harping

on about [emphasising] the importance of managing the
diabetes properly.

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Nurse:

We all nag [keep on at] you, don’t we?

Mrs H.: I don’t mind. But just think, if I hadn’t gone after

[applied for] the area manager post [job] and had to
have a medical [routine health check] it might have
been ages [long time] before they found the diabetes
and I started the insulin and a proper diet.

SEXUALITY

Some nursing/medical or Standard English words and correspon-
ding colloquial words and expressions associated with sexuality
are given in Box 5.10.

Note: Colloquial expressions used in the case histories and

example conversations are explained in brackets […].

COMMUNICATION IN NURSING

103

Box 5.10

Words associated with sexuality (for further exam-

ples see Ch. 6)

Nursing/medical or

Colloquial (everyday) or slang (very informal)

Standard English words

words and expressions used by patients

Cervix

Neck of womb

Dysmenorrhoea

Painful periods

Erectile dysfunction

Impotent

Genitalia

Bits; down below; down there, naughty bits;

private parts; privates

Menorrhagia

Flooding; heavy periods

Menstruation

Being unwell; having the curse, period(s)

Sexual intercourse

Go to bed with; intimacy; lovemaking;

make love; sex; sexual relations; sleep with;

to do/have it

Uterus

Womb

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Mr Johns has been a widower [a man whose wife has died and
has not remarried] for many years. He is generally fit [in good
health], apart from hypertension which is treated with enalapril
maleate.

Mr J.:

I’ve been under the doctor [in the doctor’s care, being
treated] for my blood pressure. She said to make an
appointment for you to check me over and do the
blood pressure.

Nurse:

What has the doctor prescribed?

Mr J.:

Innovace [proprietary name for enalapril maleate].

Nurse:

How have you been?

Mr J.:

Not bad [In English, when you have two negatives,
known as a ‘double negative’, it creates a middle way,
meaning not a positive (‘very good’), but not a negative
(‘very bad’) either].

Nurse:

What, not feeling really well?

Mr J.:

A bit seedy [unwell], but nothing specific.

Nurse:

Is there anything worrying you?

Mr J.:

I’ve met a nice lady, we really hit it off [get on well].
She likes all the same things as me, music, food and
everything.

Nurse:

Had you been on your own for long?

Mr J.:

A long time. Jenny [his wife] died of cancer 10 years
ago. I didn’t want anyone else at first, but when the
kids [children] married and moved away I felt a bit
lonely and that.

Nurse:

Yes.

Mr J.:

I met someone at work, but that soon fizzled out [came
to nothing].

Nurse:

Some men can have difficulty with erections when
taking the medicine you are on. Have you had any
trouble?

Mr J.:

It’s difficult to talk about it, but I was impotent [had
erectile dysfunction] and couldn’t do it [have sexual

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Case history – Mr Johns

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intercourse]. I told myself it was just nerves being with
someone new and tiredness.

Nurse:

Yes, it’s difficult to talk about intimate things.

Mr J.:

I’m worried about my new relationship. I don’t want
anything to go wrong like last time.

Nurse:

We’re lucky in this area to have a nurse who specialises in
the management of erectile dysfunction, that’s the medical
term for problems with erections.Would you like me to
arrange an assessment appointment with him?

Mr J.:

Yes please, I need to talk to someone. When the
doctor gave me the script [short for prescription] she
said one of the side-effects was trouble with erections,
but how could I ask her any questions? It was so
embarrassing.

Problems with menstruation have been part of Mrs Hall’s life for
as long as she can remember. First it was dysmenorrhoea as a
teenager and into her 20s, and now 20 years later she has men-
orrhagia and the dysmenorrhoea is back. She has seen the con-
sultant and the plan is for her to come in as a day case for a hys-
teroscopy and endometrial biopsy.

Nurse:

Hello again Mrs Hall. I’ve come to answer any questions
you might have about having the examination as a day case.

Mrs H.: You and the consultant explained that he would look

inside the womb [uterus] with a special instrument and
then do a scrape [dilatation and curettage] to get a sam-
ple for testing, so I’m fairly clear about what will
happen.

Nurse:

Have you any questions about the possible complications of
the procedure?

Mrs H.: No, I’m fully aware that there is a risk of the womb

being perforated.

Nurse:

You signed your consent form and consented to a general
anaesthetic.

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Case history – Mrs Hall

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Mrs H.: I didn’t fancy [like the idea of] having it done in

outpatients, I’d rather be put to sleep [anaesthetised]
first.

Nurse:

It will only be a short anaesthetic.You should be able to go
home later that afternoon/evening.Will your partner be
collecting you?

Mrs H.: Yes, he’ll come straight from work. His shift finishes at

3 o’clock, so it will be about 4 [4.00 p.m.]. Is that OK?

Nurse:

No problem, but he should ring [telephone] first just to see
if you are recovered enough to go home.You might still be
a bit sleepy.

Mrs H.: Mr Bainbridge said you could give me a date for the

examination.

Nurse:

Yes, I’ll get the dates up on the computer, but first I need to
check a few things with you.

Mrs H.: OK.
Nurse:

We do the examinations on a Wednesday morning. Are
there any dates that we need to avoid?

Mrs H.: No, we’re not going away [in this context means

away on holiday] until the problems with my periods
[menstruation] have been sorted out.

Nurse:

We will need to avoid dates when you have your period, as
it makes it difficult to get a good view of the inside of the
womb. Are your periods regular?

Mrs H.: Fairly. It usually comes every 30 days or so. The real

problem is that it lasts much longer.

Nurse:

How long?

Mrs H.: The last 3 months have been dreadful, with the heavy

bleeding going on for 7 or 8 days.

Nurse:

Does that make things difficult for you?

Mrs H.: Yes, very difficult, because I keep flooding [excessive

bleeding from the uterus]. Sometimes the blood
comes through the pad and my clothes, so I’m
scared [frightened] to go out. Plus I’m forever
washing clothes and the bedding.

Nurse:

It sounds as if your daily activities are seriously affected.

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Mrs H.: Yes, they are. I can’t plan to do anything for a whole

week every month.

Nurse:

Do you have any spotting [intermenstrual bleeding], such as
after having sexual intercourse?

Mrs H.: No, only the heavy bleeding [menorrhagia] and flooding

during my period. But it’s affecting our sex life; either
I’m bleeding or too tired.

Nurse:

The blood test we took will show if you are anaemic.
Heavy periods often cause anaemia and that would make
you tired.

Mrs H.: I really want the bleeding sorted. It’s really dragging

me down [making me ill, emotionally and physically].

Nurse:

The examination will help to find a physical cause, but
as you know Mr Bainbridge thinks that you may have
dysfunctional uterine bleeding and he might not find a
physical cause.

Mrs H.: I’m in agony [in extreme pain] with period pains

[dysmenorrhoea] as well. I used to have pain with
my periods when I was young, but this pain is
much worse.

Nurse:

What do you take for it?

Mrs H.: Just paracetamol, but they don’t do much good [not

very effective]. I know I said that I want it sorted, but
I’m worried in case he says I need a hysterectomy.

Nurse:

There are several different treatments for heavy bleeding,
such as tablets, hormones and a fairly new technique called
ablation, where the lining of the womb is removed.There is
lots to try before hysterectomy needs to be considered.

Mrs H.: I do hope so. You hear about women having a hys-

terectomy and never really getting over it [recovering],
plus all those things that happen to you.

Nurse:

What sort of things?

Mrs H.: Well you put on weight.
Nurse:

There is no reason for anyone to put on weight after a
hysterectomy other than the usual reasons of eating too
much and not getting enough exercise.

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Mrs H.: It wouldn’t feel right somehow.
Nurse:

In what way?

Mrs H.: You know – not feeling like a proper woman.
Nurse:

If Mr Bainbridge advised a hysterectomy and you were
considering it, the usual thing would be for you to see one
of us specialist nurses again to have a proper discussion
about the operation before it went ahead. But we could
talk it through [discuss fully] now if you would like to.

Mrs H.: Yes please, if you’ve got time now.

ANXIETY, STRESS AND DEPRESSION

Some nursing/medical or Standard English words and correspon-
ding colloquial words and expressions associated with anxiety,
stress and depression are given in Box 5.11.

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

108

Box 5.11

Words associated with anxiety, stress and depression

(for further examples see Ch. 6)

Nursing/medical or

Colloquial (everyday) or slang (very informal)

Standard English words

words and expressions used by patients

Anxious

Jumpy; nervy; wired (often used in connection

with substance misuse)

Depressed

Down in the dumps/mouth; feeling down; got

the hump; hacked or naffed off (also means

annoyed); low (Note: Many of these expressions

describe mild mood change rather than a

depressive illness)

Mental health problem

Barmy; batty; bonkers; cracked/crackers; crazy;

cuckoo; loony; loopy; mad; mental; nuts/nutty;

off one's chump/head/rocker/trolley; out of

one's mind; round the bend; screw loose;

screwy

Stressed

Strung out; up tight

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Note: Colloquial expressions used in the case histories and

example conversations are explained in brackets […].

Mr Reeves has always worried about things at work and often
becomes anxious if he can’t clear his desk each day. Recently, he
doesn’t seem to be able to concentrate properly and has been
staying late at work to get the day’s jobs finished. He has started
to feel anxious about returning to work after the weekend, and
on two occasions he has had a panic attack during the bus ride
to work on a Monday morning.

Nurse:

Hello Mr Reeves. I’m Nurse Owen. Is it all right if I ask you
some questions?

Mr R.:

Yes.

Nurse:

I understand that you have had some panic attacks.

Mr R.:

Yes, when I had to go back to work after the weekend.

Nurse:

Tell me what happened.

Mr R.:

It came out of the blue [suddenly, without warning].
I felt uneasy and came over [felt] all sweaty, my heart
was pounding [palpitations] and my chest felt like it
would burst. I thought I was about to snuff it [die].

Nurse:

What did you do?

Mr R.:

I tried to calm down and take some big breaths, but it
didn’t work [not effective] and I had to get off the bus
in a hurry and pushed my way off. People must have
thought I was round the bend [have a mental health
problem].

Nurse:

Did you get to work in the end?

Mr R.:

No, I needed to get home.

Nurse:

Were things any better once you got home?

Mr R.:

The panic had gone, but I felt edgy [nervous, irritable].

Nurse:

How do you mean?

Mr R.:

I couldn’t settle to anything [moved from task to task]
and was fidgety [nervously touching or playing with
things] all day.

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Case history – Mr Reeves

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Nurse:

Tell me about your job.

Mr R.:

I work for an insurance company in the claims
department.

Nurse:

What does that involve?

Mr R.:

I deal with claims from clients. It’s mainly people
damaging things at home or perhaps they have had a
break-in [burglary]. It must be dreadful and I worry
about getting the claims agreed quickly if someone has
had a break-in.

Nurse:

Do your managers put pressure on you to complete claims
within a set time?

Mr R.:

Yes, it’s all about targets and outcomes, but you must
know. It’s like that in the NHS these days.

Nurse:

Yes, most people seem to have pressures at work.

Mr R.:

It started when I wanted be the quickest to get claims
sorted out.

Nurse:

What happened?

Mr R.:

I was working against the clock [pushed for time] and
I managed for a while, but then I felt that I must
complete everything the same day.

Nurse:

Was that realistic?

Mr R.:

No, but I couldn’t see that. I stayed most evenings, but
seemed to get less and less done.

Nurse:

Why do you think that happened?

Mr R.:

I couldn’t concentrate and went from job to job without
finishing it. I couldn’t deal with claims that were any-
thing out of the ordinary [unusual].

Nurse:

How did you cope?

Mr R.:

Well I didn’t cope. I just put them to the bottom of my
pile of work.

Nurse:

How has the work situation affected your daily life?

Mr R.:

I’m finding it hard to get out of the house [leave] for
work in the mornings.

Nurse:

Anything else?

Mr R.:

Same sort of problems as the ones at work. I can’t
concentrate on one thing and keep starting things and

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then leaving it to start something else. Doing the
shopping is a nightmare [in this context means ‘an
ordeal’]. I just wander from aisle to aisle picking items
up and putting them down. It takes me over an hour
and then I forget lots of items.

Nurse:

Do you feel under stress?

Mr R.:

Most of the time.

Nurse:

What sort of things make you feel stressed?

Mr R.:

Work obviously, but things at home can hassle me [in
this context means ‘worry’] as well.

Nurse:

At home [in this context reflecting what Mr Reeves has
said]?

Mr R.:

Yes, paying bills on time and the state of the garden,
it’s like a jungle [very untidy]. When I feel uptight
[stressed] I get really fussy about piddling [petty,
unimportant] things that don’t matter.

Nurse:

What do you normally do to relieve the stress?

Mr R.:

Listening to music helps and I’ve started doing yoga
again.

Nurse:

Your GP [general practitioner] thought that our team
might be able to offer you some help.

Mr R.:

Yes, we discussed some of the options, but I need
more details.

Mel, aged 16 years, has just started at a new school. She had to
change schools when her parents split up [divorced]. It has been
difficult to make new friends and she is worried about the exams
in the summer.

Nurse:

Hello, I’m Nurse Sanchez. May I call you Mel?

Mel:

If you like.

Nurse:

What would you like to talk to me about?

Mel:

You know, I moved here last term when my mum
[mother] and dad [father] split up [divorced].

Nurse:

Yes, you came from St. Mary’s didn’t you?

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Case history – Mel

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Mel:

Yeah [yes], it was cool [OK, excellent] there.

Nurse:

How are you settling in here?

Mel:

Don’t know really.

Nurse:

What about the people in your class? Have you made
any friends?

Mel:

They’ve all known each other since year 7 [the first
year in high school]. They don’t want me – they think
I’m stupid.

Nurse:

Is that what you think?

Mel:

Yeah, ‘cos [because] of the row [quarrel] I had with that
girl who’s always talking.

Nurse:

How do you feel about the quarrel?

Mel:

It’s getting me down [depressing me].

Nurse:

Have you felt like crying at all?

Mel:

I’m usually OK, as long as [provided] they don’t keep
picking on [bully, tease] me. During PE [physical edu-
cation] I burst into tears when they made a thing about
not picking me [choosing me] for their team. They said
I was naff [in this context means ‘useless’] at sport.

Nurse:

Do feel like breaking down [bursting into tears] at other
times?

Mel:

Yeah, sometimes at home for no reason, but my mum
[mother] says I should try not to take things to heart
[try not to be too hurt by people’s remarks].

Nurse:

Did you tell your mum that you just felt like crying?

Mel:

I don’t want to worry her. She’s having a bad time.

Nurse:

Because of the divorce?

Mel:

Yeah, she was gutted [very upset].

Nurse:

How have you been feeling generally?

Mel:

Sort of sad and fed up [bored, discontented].

Nurse:

Are you able to enjoy the things you used to do?

Mel:

I can’t be bothered to get dolled up [get dressed up].
You can’t go out on your own.

Nurse:

What about hobbies?

Mel:

I used to help out at the local riding stables.

Nurse:

Yes?

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Mel:

I gave it up [stopped] when we moved to this place. I
can’t get interested in anything now.

Nurse:

Apart from what you have told me is there anything else
you are particularly worried about?

Mel:

Yeah, I’m frantic [very worried] about my exams.

Nurse:

What are you planning to do [career plans, etc.]?

Mel:

Yeah, I really want to go to uni’ [university] to do law,
so I need good grades.

Nurse:

It’s difficult changing schools just before exams.

Mel:

Tell me about it [in this context, emphasises that Mel
knows this already].

Nurse:

How is your studying going?

Mel:

I should do a plan, but I keep putting it off [delaying].
It’s easier to watch TV [television].

Nurse:

How are you sleeping?

Mel:

It’s difficult to drop off [get to sleep] worrying about
my revision.

Nurse:

What about your appetite?

Mel:

OK, if you count junk food. If my mum is out I just
have chips.

Nurse:

When you feel sad do you ever feel like harming yourself?

Mel:

No, not really. I know my mum needs me and I’m set
on [determined] being a lawyer.

Nurse:

Do you think you could talk to your mum about how
you’re feeling?

Mel:

I suppose it would be best.

Nurse:

The doctor might be able to help as well.

Mel:

Yeah, thanks.

DEMENTIA AND CONFUSION

Some nursing/medical or Standard English words and correspon-
ding colloquial words and expressions associated with dementia
and confusion are given in Box 5.12.

Note: Colloquial expressions used in the case histories and

example conversations are explained in brackets […].

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Mrs Georges has cared for her husband for over a year. His con-
dition has deteriorated rapidly and he has now been admitted to
a nursing home. He has severe dementia due to Alzheimer’s dis-
ease, and it is impossible for his wife to manage with him at
home.

Mrs G.: Hello Nurse. My husband seems quite settled now.

Would you like me to answer those questions?

Nurse:

Hello.Yes, now’s a good time.Tea will be here in half an
hour [30 minutes] or so.Will you be staying to have tea
with Mr Georges?

Mrs G.: Yes, that would be nice. It’s a real treat [pleasure] to

sit down and have a meal that someone else has
got ready.

Nurse:

Being the only carer is such hard work.

Mrs G.: At home he [her husband] wouldn’t let me out of his

sight for a minute. You can imagine how hard it is to
get a meal.

Nurse:

Yes, how are you feeling now that Mr Georges is here
with us?

Mrs G.: I know it was the right decision and had it all out

[discussed it fully] with the people from the Social
[social workers], but I’ll miss him not being at home.

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

114

Box 5.12

Words associated with dementia and confusion

(for further examples see Ch. 6)

Nursing/medical or

Colloquial (everyday) or slang (very informal)

Standard English words

words and expressions used by patients

Confused

At a loss; at sea; at sixes and sevens; befuddled;

bewildered; mixed up; muddled; muzzy;

not with it

Demented

Crack brained; crazed; crazy; daft; dotty;

non-compos mentis

Case history – Mrs Georges

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It had to happen. I’m completely done in [exhausted
or worn-out].

Nurse:

Tell me about Mr Georges.

Mrs G.: I wish you could have seen him before all this

happened. He was so on the ball [alert] and always
helping people. He was in the merchant navy and
spent months away, so I was used to being on my
own before he retired.

Nurse:

Have you got family nearby?

Mrs G.: I won’t be lonely. Our lad [son] lives just around the

corner. I really lost my Bob [Mr Georges] when his
mind started to go.

Nurse:

When did you first notice?

Mrs G.: Hard to say [difficult], I suppose you expect your

memory to get worse, so you put the little lapses
down to [caused by] him getting older.

Nurse:

Well we all lose our glasses and forget names.

Mrs G.: Yes, but it was more than that. He seemed muddled

[confused] by everyday things like making a pot of tea.
He would put the teabags in the kettle or make the tea
with cold water.

Nurse:

How was he in himself?

Mrs G.: At first he knew something was wrong. He was

frustrated and would fly off the handle [be irritable]
with me and I would snap back. I didn’t realise he
couldn’t help it [not his fault].

Nurse:

How do you feel about it now?

Mrs G.: Real bad. I feel weepy [tearful] just talking about it.

Silly isn’t it?

Nurse:

No it’s not silly, not at all.

Mrs G.: After 40 years married we knew what the other was

thinking most of the time and now we’re not even on
the same wavelength [don’t understand one another].

Nurse:

What other things have been happening?

Mrs G.: He would witter on and on [go on] about the same

thing and asking me the same question. I’d say to him

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‘Bob you’re driving me up the wall [irritating me]’, he’d
smile and next minute do it again. But he hardly says a
word now [does not speak very much].

Nurse:

What about washing and dressing?

Mrs G.: Gets in a right pickle [difficulty] with dressing. I have to

help him. It’s as if he can’t remember what to do.
Getting him to shave is a right carry-on [performance],
he just won’t do it and pushes me away if I try to help.
I hate to see him so scruffy [untidy]. He was always so
particular with his turn out [clothes and appearance]. I
don’t know whether you’ll have better luck with him.

Nurse:

The care assistants have special training sessions and
they’re all used to looking after people who have problems
like Mr Georges’.

Mrs G.: But they won’t know how to stop him getting in a

lather [agitated].

Nurse:

Would you like to meet the team who will be caring for
Mr Georges, so you can tell them about the best way to do
things? Most relatives say it’s reassuring.

Mrs G.: That would put my mind at rest [feel reassured] about

leaving him here. I will just say that he seems to like
sitting in front of the box [television]. He can’t know
what’s on but he does seem calmer. Before he got this
bad he was forever changing channels and I never got
to see the end of anything.

Nurse:

How frustrating for you. Does Mr Georges wander about?

Mrs G.: In the last few months it started. He kept wandering off

during the day. He was off like a shot [moved quickly]
and he’d be in the road before I got out the house. I
was sure he’d be under a car at any moment [have a
road accident]. And then he stopped knowing day and
night and would get up [out of bed] at all hours of the
night. That really scared me. What if he’d turned on
the gas [the gas cooker/oven]? He was always fiddling
[touching] with it during the day.

Nurse:

That must have been a real worry.

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Mrs G.: I’d lay there in the dark listening for him getting up,

and when I dropped off [got to sleep] any little noise
would wake me. That’s what really decided me about
him coming here.

Nurse:

I just heard the tea trolley go by.We can finish this later if
you like.

Mrs G.: I could do with a cuppa [usually refers to a cup of tea]

I’m parched [thirsty].

PAIN

Some nursing/medical or Standard English words and correspon-
ding colloquial words and expressions associated with pain are
given in Box 5.13.

Note: Colloquial expressions used in the case histories and

example conversations are explained in brackets […].

COMMUNICATION IN NURSING

117

Box 5.13

Words associated with pain (for further examples

see Ch. 6)

Nursing/medical or

Colloquial (everyday) or slang (very informal)

Standard English words

words and expressions used by patients

Analgesic

Painkiller

Grimaces

Pull a face

Pain

Ache; agony; cramp; discomfort; hurt; irritation;

smarting; soreness; spasm; tenderness; throb;

twinge (see text for more words used to

describe pain)

‘Pain’ and ‘ache’ mean the same thing and we speak of ‘aches

and pains’ generally. Both these words are nouns, but the word
‘ache’ can be used with the following to form a compound noun:
backache, earache, headache, stomach-ache (usually means an

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ache in the abdomen), toothache. For the other parts of the body,
we say:

‘I have a pain in my shoulder, chest, etc.’

It is possible to have a pain in the back, head and stomach

(usually means the abdomen), but this generally refers to a more
serious condition than backache, headache and stomach-ache.

The word ‘ache’ can also be used as a verb:

‘My leg aches after walking 10 miles.’

‘My back aches after gardening.’

The word ‘hurt’ is another verb used to express injury and

pain:

‘My chest hurts when I cough.’

‘My neck hurts when I turn my head.’

How patients describe pain: commonly used words

— aching
— beating
— biting
— boring
— burning (as in cystitis, oesophagitis)
— bursting
— colicky (often used to describe the pain that results from

periodic spasm in an abdominal organ (biliary, intestinal),
but also used to describe renal colic and dysmenorrhoea)

— crampy
— crushing (as in angina pectoris or myocardial infarction)
— cutting (rectal disease)
— discomfort (may describe mild pain sensation)
— dragging (as in uterine prolapse)
— drawing
— dull (headache, tumour)
— gnawing (tumour) (pronounced nawing)
— grinding

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— griping
— gripping (as in angina pectoris)
— heavy (as pre-menstrual)
— knife-like
— numb (lack of sensation)
— piercing (angina pectoris)
— pinching
— pounding (headache – ‘My head is pounding’)
— pressing
— prickling (as in conjunctivitis)
— scalding (cystitis)
— severe pain (gip – ‘It gives me the gip’)
— sharp
— shooting (sciatica, toothache)
— sickening
— smarting (burns)
— sore
— spiky
— splinter-like
— stabbing (indigestion)
— stinging (cuts, stings)
— stitch (sudden sharp pain usually due to spasm of the

diaphragm)

— straining
— tearing
— tender
— throbbing (headache, an infected area)
— tingling (return of circulation to extremities)
— twinge (sudden, sharp)
— twisting.

Pain may also be described as being: acute, agonising, chron-

ic, constant, constricting, convulsive, darting, deep-seated, diffi-
cult to move, diffuse, excruciating, fleeting, intense, intermittent,
localised, mild, obstinate, persistent, radiating, severe, spasmod-
ic, spreading, stubborn, superficial, very severe, violent.

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Miss Carter has had migraine attacks for many years, but recently
they are coming more often and her usual tablets are not as effec-
tive. This has led to her having several days off sick from work.

Miss C.: My heads [in this context meaning the ‘migraine

attacks’] are getting worse. I wish I knew what brings
it on [causes it].

Nurse:

When did you start having migraine?

Miss C.: Oh, years ago when I was still at school, but now

they’re coming every couple of weeks.

Nurse:

How does that differ from before?

Miss C.: I only had them once in a blue moon [very

infrequently], but always when I was planning
to do something special.

Nurse:

Can you think of any reasons why they’re coming more often?

Miss C.: Well, I’ve got a new job and it’s more stressful.
Nurse:

Can you do anything about that?

Miss C.: No chance at the moment.
Nurse:

What about things like certain foods, or drinks [in this
context alcoholic drinks]. Have you noticed any link?

Miss C.: I know to lay off [give up] chocolate. But now it’s really

spooky [weird, strange]. Sometimes I have a sip of
wine and my head feels tight and I just know that a
migraine is on its way [going to occur], and other times
I have two or three glasses and get away with it
[escape having a migraine attack].

Nurse:

Is it a particular type of wine?

Miss C.: No, sometimes red and sometimes white wine.
Nurse:

Does anything special make it worse once you’ve got the
pain?

Miss C.: Yes, any bright light. You know like sunlight on water.

It’s no problem ‘cos [because] I always have my dark
glasses with me until I can get into bed.

Nurse:

What about the migraine attacks? Have they changed?

Miss C.: The throbbing is much worse. It’s so bad I have to lie

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Case history – Miss Carter

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on the bed and try to sleep.

Nurse:

Do you take anything for the pain?

Miss C.: I always used to take a painkiller [analgesic] and the

pain would soon go off [stop], but no joy [failure] now.
Nothing seems to shift the pain [relieve the pain].

Nurse:

Which painkillers?

Miss C.: Mostly Panadol [a proprietary name for paracetamol],

but sometimes ibuprofen. It depends on what I have
with me.

Nurse:

Over the last few years much better drugs have become
available for migraine.

Miss C.: Yes, I knew that, but it didn’t matter while the Panadol

still worked OK.

THINKING ABOUT (REFLECTION) PRACTICE:
EXERCISE

Think about a recent time at work when you needed to get infor-
mation, or help patients/clients/relatives to understand something
to do with their care.

— Who was the person?
— What did you need to find out or tell them?
— How did you start the conversation?
— Did you get the information you needed, or were you suc-

cessful in helping the person understand something?

— Did you have any difficulty understanding everything the

patient/client/relative said to you?

— Do you think that they understood everything you said?
— Which parts of the communication were good and what

helped to make it so?

— Which parts were less successful and what stopped them

working so well?

Consider the answers you have given and pick out what you

have learned from this situation. What, if anything, would you do
differently if the same sort of situation happened again?

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FURTHER READING

Holland K, Jenkins J, Solomon J, Whittam S 2003 Applying the

Roper–Logan–Tierney model in practice. Churchill
Livingstone, Edinburgh.

Roper N, Logan WW, Tierney AJ 1996 The elements of nursing,

4th edn. Churchill Livingstone, Edinburgh.

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Colloquial English

LANGUAGE USED BY PEOPLE TO DISCUSS PROBLEMS
OR SIGNS AND SYMPTOMS

Many people, especially older people, find extreme difficulty in
discussing their bodily functions and signs and symptoms of a
disorder with a health worker. This may be from not knowing the
correct words, or shyness. Obviously, the more intimate the part
of the body, the greater the embarrassment, and so a wide vocab-
ulary of euphemisms and slang expressions has sprung up in the
English language.

Quite often the person is so inarticulate that you will have to

suggest various problems or symptoms and the person merely
says ‘yes’ or ‘no’. In some situations, the nurse or doctor may
have to use colloquial expressions. However, there is consider-
able risk of misunderstanding and it is safer to use the correct
terms and check that the person has understood.

Colloquial expressions show considerable regional differences.

A few are included in this chapter, but it is important that you
become familiar with those used locally. The expressions that
people use are also influenced by their age and culture, and again
you should note the expressions used locally. Those phrases
which are most commonly used have been printed in italics (e.g.
back passage). Many colloquial expressions you will hear are con-
sidered to be vulgar, offensive or discriminatory in some way.
You should not use them, and those that are not commonly used
in polite society, have been marked with an asterisk (*).

PARTS OF THE BODY

Anus – arse*, arsehole*, back passage, butt*, butthole*, hole*.

To break wind: to fart*, to poop*, to trump*.

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Bladder – waterworks, e.g. Nurse to patient: ‘How are the water-

works?’ or
How is your bladder working?

Bowels – gut, e.g. a pain in one’s gut, to have belly ache (often

used to mean bowels), to have gut ache.

Brain – head-piece, noodle, nut (e.g. use your nut).
Breast – boobs*, bosom, buffers*, charleys*, chest, chestnut*,

globe*, knockers*, nipples, paps*, tits*, titties*, top part.
Imitation breasts: falsies. Small breasts: ‘I haven’t got much’.

Buttocks – arse*, backside, behind, bottom, botty (childish),

bum*, buns* (male), cheeks, hind quarters, posterior, rear,
rump*, seat, sit-upon, stern, tail, toby.
To have large buttocks: to be broad in the beam.

Cervix – neck of womb.
Chest – to have a flat, barrel, hollow, pigeon chest.

The following are only used for females:
bosom, breast, buffers*, bust.
To have a bad cough: to bark.
Coughing: to be chesty, a bit chesty.
To have one’s chest finger-tapped: to have a thump.

Clitoris – clit*.
Crotch – often used to mean groin or skin covering genitalia.
Ear – bat ears (prominent), a cauliflower ear (from boxing), flap-

pers, lug* (e.g. to have lugache*).
Rather deaf: to be hard of hearing.

Elbow – funny bone, e.g. to hit one’s funny bone (so called

because of the strange tingling one experiences when it is
struck).

Enlargement of abdomen in older people – middle-age

spread.

Eyes – glimmers*, ogles*, optics, peepers.

To have a squint: to be boss-eyed, to be cock-eyed, to be

wall-eyed.

To have low visual acuity in one eye: to have a lazy eye.

Face – clock*, dial*, mug*, physog*.
Genitals – male and female: bits, package, down below, private

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parts, thing, pencil and tassle* (male child’s penis and scrotum).

Hand – mitt, paw.
Head – bonce; brain-box, brain-pan, napper, nob, noddle, nous-

box (nous means intelligence, common sense), nut, skull.

Heart – engine, e.g. ‘my engine’s not working properly’, jam tart*

(Cockney), ticker.
Something wrong with one’s heart: to have a dicky heart.
To have a weak heart: to have a heart.

Hymen – cherry, maidenhead, maid’s ring (Cockney).
Intestines – bowels, guts, innards, inside.
Legs – bandy legged (bow), drumsticks (very thin), K-legged

(with knees knocking together), knock-kneed (knees bent
inwards to face each other), peg leg (an artificial leg), pins,
spindles.
A lame leg: to have a gammy leg.
Short legs: to have duck’s disease.
Walk badly: to be bad on one’s pins.
Walking with the feet turned in: hen-toed.

Lungs – bellows, tubes.

To be bad in one’s breathing: to be short-winded.

Mouth – chops*, gob* trap*.
Navel – belly button.
Neck – Adam’s apple (projection of thyroid cartilage of larynx),

salt cellars (very deep hollows above collar-bone in female
neck), scruff of neck (nape).

Nose – beacon* (red and large), beak*, conk*, hooter*, sniffer*,

snitch*.
Nasal congestion: to be blocked up, bunged up, stuffy.
Nasal discharge: snot*.
Noisy breathing in children due to nasal congestion: snuffles.
Running nose: a snotty nose*.

Penis – almond*, almond rock* (Cockney), bean*, button* (baby),

club*, cock*, dick*, equipment*, gear*, it*, John Thomas*, knob*,
little man*, little tail* (small boys), meat*, old man*, Peter*, pin-
kle*, prick*, private parts, privates, rod*, shaft*, she*, stick*,
tadger* (Northern England), tassel*, thing*, tool*, Will*, Willie*.

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Scrotum – bag*, sac.
Skull – brain pan.
Spine – backbone.
Stomach – abdomen, belly, bread-basket*, corporation (when

large), croop, guts (stomach and intestines), innards, inner
man, peenie, pinafore, tummy.
To belch: to burp.
The noise the stomach makes when one is hungry: to have

stomach rumbles.

Something wrong with it: to have a gastric stomach.
Stomach ache: to have a pain in one’s guts.

Teeth – buck teeth (protruding); peggy, peggies (childish).
Testes/testicles – ballocks*, balls*, bollocks*, charleys*, cobblers*,

cods*, nuts*, pills*, pillocks*, stones*. See Genitals.

Throat – clack*, gullet, organ-pipe (windpipe).

A very severe cough: a churchyard cough.
Sputum: phlegm.
To be hoarse: to have a frog in the throat.
To have a sore throat: to have a throat.

Tongue – clack*, clapper*.

The tongue can be described as: coated, dirty, furred, furry,

thick.

Talkative person: a chatterbox.

Trachea – windpipe.
Umbilicus – belly button (childish), navel.
Urethra – pipe, waterpipe.
Uterus – box, womb.
Vagina (or vulva) – birth canal, box*, brush*, crack*, cunt*,

down below, fanny*, front passage, hair pie*, it, private (e.g.
‘my private is sore’), private part, pussy*, slit*, thing*, there,
twat*, up inside.

BODY FUNCTIONS

Constipation, to have – to be bunged up, to be costive, I haven’t

been for 4 days. I haven’t had a road through me for a week*.

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Defaecate, to – to crap*, to do a big job, to do a job, to do a

pooh (childish), to do a rear*, to do number two, to do one’s
business, to go to the toilet (and use paper), to have a clear
out, to have the bowels opened, to job*, to pass one’s motions,
to shit*, to use a bedpan (hospital).

Diarrhoea, to have – the trots, collywobbles, Gippy tummy,

run’ems, runs, scours, squitters.
To have a sudden attack of diarrhoea: to be taken short.

Die, to – to be a goner, to be all over, to be slipping (to be

dying), to burn oneself out (die early through overwork), to
conk out, to go (go away), to go home, to go to the next
world, to hang up one’s hat, to have had it, to have one’s num-
ber up, to have had one’s chips, to have one foot in the grave
(to be dying), to kick the bucket, to pass away, to peg out, to
pip out, to pop off (usually die suddenly), to push up daisies,
to snuff it or out, to turn it in, to turn one’s toes up, to have
had a long (or good) innings (to die at an old age), to lay out
(prepare for burial or cremation).
Note: To commit suicide: to kill oneself.

Faint, to – to black out, to have a black-out, to go off hooks, to

pass out.

Faeces, stools – baby’s yellow (infantile excrement), business,

cack*, job*, mess*, motions, number two, shit*.
Nurse to patient: ‘Are your motions well formed?’.
Mothers often say of a child: ‘His toilet is green’ (meaning his

stools are green).

Note that ‘a dose of salts’ means Epsom salts.
Tenesmus: straining.

Impotent, to become – to be no good to one’s wife, to lose

one’s nature.
A man’s impotence will be expressed by his wife/partner in

the following ways: he can’t sustain an erection, he can’t
manage, his cock’s soft or droopy*. Doctor to man: ‘Can
you get a hard on?’.

Menstruate, to – to be unwell, one’s period, the curse, the days,

the monthlies, the other, the thing, the time of the month, the
usual.

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‘Have you seen anything?’ (feminine euphemism).
‘I haven’t seen for 6 weeks’ (no menstruation, possibly preg-

nant).

Nurse to patient: ‘When was your last period?’

Naked, to be – to be in one’s birthday suit, to be in the altogeth-

er, to be starkers.

Pregnant, to be – away the trip* (Scottish working class), to be

caught*, to be expecting, to be having a baby, to be in a deli-
cate condition, to be in an interesting condition, to be in Kittle
(Scottish), to be in pig*, to be in pod*, to be in the club*, to be
in the family way, to be in the pudding club*, to be one in
line*, to be preggers*, to be up the duff*, to be up the pole*,
to be up the stick*, to catch on, to catch the virus*, to click*,
to cop it*, to fall for a baby (to have an unwanted pregnancy),
to have a bun in the oven*, to have a touch of the sun*.
She’s 6 months pregnant: she’s 6 months gone.

Sleep, to – to close one’s eyes, to doze (short sleep), to go off (to

fall asleep), to go to the land of nod, to have a catnap (short
sleep), to have a doze, to have a snooze (short sleep), to have
forty winks (short sleep), to have some shut-eye, to nod off
(short sleep), ziz.

Urinate, to (micturate) – to do number one, to go to the loo, to

have a run-out, to pass water, to pee, to pee-wee (childish), to
piddle*, to piss*, to spend a penny (women only), to tiddle
(childish), to tinkle (women only), to wee-wee (childish).
Nocturia: to get up in the night to pass urine.
Hostess to guests: ‘Do you want to wash your hands?’ (Do

you want to go to the toilet?).

The lavatory can be described as: bathroom, bog*,

cloakroom, convenience, Gents’, heads*, Ladies’, lav,
lavvy, little girls’ room, loo, place, powder room (Ladies’
in a hotel), privies, rears*, toilet, WC.

A chamber pot: banjo*, gerry*, po, pot, potty (childish).
To hold a baby over a chamber pot: to hold out a baby.
To put a baby on a chamber pot: to pot.

Vomit, to – to be ill, to be sick, to bring up, to lose the lot, to

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puke*, to pump your heart up, to sick up, to spew*, to throw
up*.
Nausea: the sicks.
To have nausea: to feel queasy, to feel sick.
‘Have you vomited?’ ‘Have you been sick?’
To try to vomit but nothing comes up: to retch.
To vomit very much: to be as sick as a dog (or cat).
To have a headache and vomiting: to have a sick headache.

Weep, to – to blub, to blubber, to break down, to cry, to turn on

the waterworks, to turn the tap on.

MENTAL AND PHYSICAL STATES

Angry, to be – to be cross, to be crusty, to be heated, to be hot

under the collar, to be liverish, to be livid, to be shirty, to be
steamed up, to flip, to fly off the handle, to go off the deep
end, to have a paddy, to have a tantrum, to jump down some-
one’s throat, to let off steam, to lose one’s hair, to lose one’s
shirt, to play the devil, to see red.

Confused, to be – to be all at sea, befuddled, bewildered, disori-

entated, flummoxed, forgetful, muddled, muzzy, unsure.

Depressed, to be – to be blue, to be browned-off, to be down in

the dumps, to be down in the hips, to be down in the mouth,
to be fed up, to be low, to be off the hinges, to have a button
on, to have a chopper, to have a face as long as a fiddle, to
have the droops, to have the hump, to have the hyp, to have
the mopes, to have the pip.

Drunk, to be – to be a dipso (dipsomaniac), to be boozed

(boozy), to be fou*, to be fresh (slightly drunk), to be fuddled
(confused with drink), to be high on surge (to be drunk on
surgical spirit), to be lush (slightly drunk), to be merry (happy
with drink), to be muzzed, to be on the bottle (habitual
drinker), to be paralytic (very drunk), to be pie-eyed, to be
plastered, to be slewed, to be sloshed, to be soaked (very
drunk), to be sozzled (very drunk), to be squiffy (slightly
drunk), to be tiddly (slightly drunk), to be tight, to be tipsy

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(slightly drunk), to be under the influence (of liquor), to be
well-oiled, to be woozy (confused with drink), to have a skin-
ful (very drunk), to have Dutch courage (extra courage
induced by alcohol), to have more than one can carry, to have
one over the eight, to see pink elephants (or spiders) (to suf-
fer from DTs), to have a hangover (to feel ill as a result of alco-
hol), to have a morning-after-the-night-before (to feel ill as a
result of alcohol), to hit the bottle (to drink excessively).

Dull, to be – to be a dream, a drip, a moron, a muggins, a noo-

dle, a pie-can, a sap*, a wet, dead alive, dopey, dumb, foolish,
goofy, half-baked, half-witted, lethargic, mutton-headed, silly,
simple, slack, slow, soft, stupid, thick, thick-skulled.

Exhausted, to be – to be all in, to be clapped out*, to be dead,

to be done for, done in, done up, to be fagged out, to be fin-
ished, to be flaked out, to be jiggered, to be knackered*, to be
knocked up, to be ready to drop, to be shagged*, to be shat-
tered, to be tired out, to be used up (utterly exhausted), to be
weary, to be whacked, to feel like death, to go all to pieces
(collapse from exhaustion).
To knock it out of one, ‘walking uphill knocks it out of me’

(walking uphill exhausts me).

Healthy, to be – to be A1, to be as fit as a box of birds, to be as

fit as a fiddle, to be fighting fit, to be first rate, to be full of
beans, to be in fine fettle, to be in the pink, to be on good
form, to have plenty of pep (pep = energy), to have plenty of
vim (energy, vigour), to perk up (recover good health).
To begin to recover after an illness: to be on the mend, to

turn the corner.

Madness – (in varying degrees): to be a bit touched, to be a

case, to be a character (to be eccentric, odd), a scatterbrain
(very forgetful, vague), to be as mad as a hatter, balmy,
(barmy), bats, batty, bonkers, to be clean gone, cracked,
crackers, crack-pot, crank, crazy, to be dippy, dotty, gaga
(senile), goofy, half-baked, kinky, loony, loopy, mad, to be
mental, non compos mentis, not all there, to be not right in
one’s head, nuts, off one’s block, off one’s chump, off one’s

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head, off one’s nut, off one’s rocker, to be off the rails, out of
one’s mind, to be peculiar, potty, round the bend, scatty, a
screwball, screwy, silly, simple, soft, stupid, up the creek,
weak in the upper storey, to go doolally, to go hay-wire, to
have bats in the belfry, with a tile (or screw) missing (or
loose).
Psychiatric (mental) hospital: bin, funny farm, loony bin,

nuthouse.

Nervous, to feel – to be a fuss-pot, to be a jitter-bug, to be all

hot and bothered, to be all of a dither, to be chewed up, to be
edgy, on edge, to be fidgety, to be in a blue funk, to be in a
flap, to be in a stew, to be in a tizzy, to be jittery, to be
screwed up, to be shook-up (nerve-racked), to get all het-up,
to get in a state, to get uptight, to go all hot and cold, to go
into a flat spin, to go to pieces (collapse through nerves), to
go up the wall, to have ants in one’s pants*, to have butterflies
in one’s stomach, to have forty fits, to have kittens, to have the
creeps, to have the heebie-jeebies, to have the shakes, to have
the shivers, to have the twitters, to have the willies, to have
the wind up, to have the worrits, to lose one’s cool, to worrit
(be anxious).

Unwell, to be – to be anyhow, to be below par, to be groggy,

to be not oneself, to be not quite right, to be off colour, to be
out of sorts, to be peaky, to be pingley, to be poorly, to be
run down, to be taken bad, to be tenpence to the bob, to be
under the weather, to be washed-out, to be weedy (anaemic,
sickly), to be wobbly (weak after an illness), to be wonky
(weak), to come all over queer, faint, ill (suddenly feel
unwell), to crack up, to feel a bit off it, to feel a bit rough, to
feel funny, to feel half-baked, to feel like death warmed up
(very unwell), to feel like nothing on earth, to feel lousy, to
feel queer, to feel ragged, to feel seedy, to go funny, to have
a bad turn.

Vertigo – to be dizzy, to be giddy, to be muzzy, to feel the room

spin, to feel queer, to have a mazy bout, to have a swimming
head.

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GENERAL EXPRESSIONS

(In this section the text in bold type is the colloquial expression.)

Dope, physic – any kind of medicine.
Medicine – anything taken to relieve pain or symptoms of illness.

Usually the word refers to liquid or drugs taken by mouth.

Pills, tablets – drugs in tablet form. Note: to be on the pill: to be

taking the contraceptive pill.

A tonic – medicine to invigorate one after an illness.
To be at death’s door, to be critical, to be nearly a goner – to

be dangerously ill.

To be laid up – to be confined to bed, e.g. ‘I was laid up for

3 months’.

To be looking up – to improve.
To be off sick, to be on the sick-list, having a sicky – to be

absent from work due to illness.

To be on the mend – to improve.
To be nesh, to be soft – to be prone to illness.
To be under a doctor – to be in a doctor’s care.
To find one’s legs – to begin to walk after an illness.
To get a chit from the doctor – to get a medical certificate.
To go under – to have a general anaesthetic.
To have a bad turn – to become ill suddenly.
To have a bug, a germ – to have an infection.
To have a check-up – to be medically examined, or have a

screening test.

To have a jab – to have an injection.
To have a set-back – to have a relapse.
To have a temperature – to be pyrexial or feverish, to have a

high temperature, e.g. ‘I’ve had a temperature all day’.

To have gas – to have a general anaesthetic.
To have painkillers – to have analgesics.
To have sleeping pills – to have sedatives.
To have time off – to have sick leave.
To stitch – to suture.

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To suck lozenges – to suck small tablets, usually for coughs and

sore throat.

To take a turn for the better – to improve.
To take medicine for the bowels – to take a laxative.
To take stitches out – to remove sutures.
To turn the corner – to improve.

REPRODUCTIVE AND SEXUAL HEALTH PROBLEMS

The vocabulary to express menstruation and pregnancy is listed
separately under body functions (see p. 126–129).

Women’s health expressions

Abortion (Note: In practice it is usual to refer to an abortion as

a ‘miscarriage’ to avoid causing distress, as some women will
associate the term abortion with a deliberate termination of
pregnancy) – spontaneous miscarriage, a miscarriage, a miss*.
‘It came away.’ ‘I lost my baby’ or ‘We lost our baby.’

Candidiasis – vaginal thrush.
Confinement – childbirth, delivery. ‘Did you have an easy con-

finement?’

Dilatation and curettage – D&C, a scrape, e.g. ‘I’ve had two

D&Cs’ (two scrapes).

Dysmenorrhoea – period pains, to be unwell.
Efforts to terminate a pregnancy – to bring on a period, to

lose it (a baby), to get rid of a baby. ‘They took the baby
away.’

Episiotomy – to make a perineal cut. ‘I’m going to cut you now.’
Flooding – excessive bleeding from the uterus during

menstruation.

Hot flushes and night sweats, to have – to have a feeling of

being hot, looking hot and red, and sometimes sweaty.
Associated with the menopause.

Hysterectomy – to have an internal operation, to have a major

operation, to have all taken away (uterus and ovaries).

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Menarche – the beginning of menstrual periods, e.g. ‘When did

your periods start?’.

Menopause – the end of periods, e.g. ‘When did your periods

end?’, the change, that certain age, the time of life.
I haven’t seen anything for 6 months.
It’s your age. It’s the time of life.

Menorrhagia – heavy periods.
Parturition – labour, to be in labour. ‘How often are you having

contractions?’

Placenta – the afterbirth.
Repair of the prolapse – ‘I was stitched up below’, to be

hitched up.

Rupture the membranes, to – to break my waters.
Sanitary towels – pads, STs, Tampax (a brand of tampons worn

internally), towels, wings.

Still-born baby – baby born dead.
Suture – to be stitched up.
Termination of pregnancy – an abortion. ‘I don’t want this

baby. Can I have an abortion?’ ‘I did away with it.’* ‘I decided
not to go ahead with the pregnancy.’

Vaginal discharge – to have whites, to lose down there.

‘Something comes away from me ...’

Version – turning (of fetus).

Men’s health expressions

Coitus interruptus – to be careful, to withdraw. ‘My husband’s

very careful.’

Ejaculate, to – to come, to get your rocks off*, to shoot.
Erection, to have an – to have a hard on, to have a stand*, to

have a stiff*, to have the horn*.

Impotent (now known as erectile dysfunction), to be – to

have a half-stand*. ‘I can’t keep it up.’ ‘My husband has trouble.’

Impotent, to become – to lose one’s nature.
Semen – come, cum, jizz.

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Sexual health expressions

Anal intercourse – buggery, bumming*. ‘He wants to come at

me from behind.’* To rim*.

Bisexual – AC–DC*, to be double-jointed*.
Dyspareunia – love pain.
Female homosexual/lesbian – to be gay, kinky*, to be butch (a

lesbian with male characteristics), a dyke*, a lessie*.

French kiss – kiss with mouth open and insert tongue in part-

ner’s mouth.

Heterosexual – straight.
Homosexual expressions – to be the active/passive partner,

eating ass*, reaming*, tonguing (using the mouth on anus),
finger fucking*, fisting* (using finger/fist in anal canal).

Illegitimate, to be – to be a bastard, to be born on the wrong

side of the blanket, to get into trouble (unmarried pregnancy),
to have a natural child.

Male homosexual – bent*, a fag*, a faggot*, a fairy*, a nancy-boy*,

a pansy*, a pouf*, a poufter*, a queen*, a queer*, gay, kinky*.

Oral sex – blow job*, give head*, to go down on someone, rim-

ming*, sixty-nine* (mutual oral sex), to suck off.

Orgasm – climax.

To experience an orgasm: to come, to have a thrill. ‘When I

come.’ ‘When he’s finished.’

Sexual intercourse – intimacy, to do it, to fuck*, to get it with,

to get layed, to go with someone, to go to bed with someone,
to have it, to have sex, to knock up*, to make love, to perform,
to shag*, to roger, to screw*, to sleep with.

To have a regular sexual partner – to go steady. ‘We’re an item.’
To masturbate – to beat off*, to bring oneself off*, to fiddle*, to

jack off*, to jerk off*, to rub up*, to shag*, to shake*, to toss*,
to wank* (wanker: masturbator).

To neck – hug and kiss intimately.
To pet – kiss and caress extensively.

Sexual intercourse is often referred to as a normal married life

by older people. Note the negative use, such as ‘We can’t have a

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normal married life’. Also, ‘He doesn’t trouble me’, meaning the
husband/partner does not demand sexual intercourse if the
woman does not want it. ‘He doesn’t bother about that sort of
thing’ implies a not very demanding partner. ‘He wants it too
often’ means a demanding one.

Phrases such as, ‘When I go with my husband’, When we have

it’, ‘When we have sex’, ‘When he does it’ are most commonly
used.

Family planning, contraception

Condom – briefs (short condoms), Durex (trade name often used

as a synonym), envelope, French letter, Johnny*, jolly bag*,
rubber*, sheath, skin.

Diaphragm – Dutch cap, cap.
Emergency contraception – morning after pill.
Female condom.
Intrauterine contraceptive devices (IUCDs) – the coil.
Oral contraceptive – the pill.

Assisted conception, fertility clinic

Frequency of sexual intercourse – ‘How often do you try for a

baby?’, ‘When and how often do you have intercourse?’

In vitro fertilisation (IVF) – test tube baby.
Tubal insufflation – I had my tubes blown.

Sexually transmitted (acquired) infections (STIs, SAIs)

Gonorrhoea – clap, gleet, morning drop, strain, tear, a dose, the

whites, to catch a cold.

Primary syphilis – bumps (African Caribbean).
Pubic lice – crabs, to be chatty*.
Seminal fluid – your husband’s fluid.
Sexual health centre/clinic – GUM clinic, special clinic, VD

clinic

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Syphilis – bad blood, lues, pox, siff.

Expressions:

To have a double event (syphilis and gonorrhoea).
To piss pins and needles*.
Scalded (infected with gonorrhoea).
Expressions used by patients:
I’ve been to the GUM clinic.
I’ve picked up something.
I’m afraid I’ve got it.
I’ve caught (or got) something.
I’ve got a dose (gonorrhoea).
I’ve got a full house* (syphilis and gonorrhoea).
I’ve got genital warts.
I’ve got trouble down below.
I’ve noticed something odd.
I’ve got trouble with my meat*.
I’ve been after the girls (or men).

Note: ‘The whites’ may be used by women to mean any white

vaginal discharge.

African Caribbean individuals may use ‘scratch’ for irritate or

itch, e.g. ‘It scratches me’ means ‘It irritates and I want to scratch’.

Prostitutes (sex workers) may say, ‘I’m a business/working

girl’, ‘I’m on the game’.

The health professional in the sexual health clinic will ask:

‘Have you any discharge?’, ‘Does it irritate?’, ‘Do you have pain
when you pass water?’, ‘Have you any swelling?’, ‘Have you a
sore place?’, ‘Have you a rash?’.

GLOSSARY OF MEDICAL AND COLLOQUIAL NAMES

Medical name

Colloquial name

Alopecia

baldness

Arteriosclerosis

hardening of the arteries

Blepharitis

sore eyelids

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Bursitis

housemaid’s knee, tennis elbow

(see epicondylitis)

Cancer

a growth, the big C, the worst,

tumour

Candidiasis; monilia

thrush

Cerebral palsy

to be spastic

Cerebrovascular accident stroke
Colic

gripes

Concussion

KO’d, to be concussed, to be

knocked out

Conjunctivitis

pink eye

Contusion

bruise

Convulsions

fits

Coronary thrombosis;

a coronary, heart attack

myocardial infarction

Coryza

cold

Dandruff

scurf

Delirium tremens

DTs, the jerks, the shakes

Diabetes mellitus

sugar diabetes

Dysmenorrhoea

painful periods

Dysphagia

difficulty swallowing

Dyspnoea

breathless, out of breath, panting,

puffed, short of breath

Dyspepsia

indigestion

Encephalitis

brain fever

Enuresis

bed-wetting

Epicondylitis

golfer’s elbow (medial side),

tennis elbow (lateral side)

Epistaxis

nosebleeds

Eructation

belching

Erythema pernio

chilblains

Flatulence, flatus

wind. Note: To belch (to send out

wind from stomach noisily),
to fart* (to send out wind from
anus)

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Frequency

I keep wanting to go (to pass

urine)

Furuncle

boil

Gonorrhoea

clap

Haemorrhoids

piles

Halitosis

bad breath

Hernia

rupture

Herpes simplex

cold blister or sore

Herpes zoster

shingles

Hordeolum

stye

Hydrophobia

rabies

Hypertension

high blood pressure

Incontinence

leaky, not to be able to hold

one’s water or motions, to
have an accident

Infectious mononucleosis glandular fever
Influenza

flu

Leucorrhoea

whites

Menopause

the change (of life), the turn (of

life)

Menstruation

period(s)

Myopia

short-sight

Neuralgia

face ache

Nocturia

to get up at night (to pass water)

Oedema

dropsy, swelling

Osteoporosis

brittle bone disease

Parotitis (infectious)

mumps

Pediculosis capitis;

nits

head lice

Peritonsillar abscess

quinsy

Pertussis

whooping cough

Poliomyelitis

infantile paralysis, polio

Pruritus

itching

Pyrexia

fever, a high temperature

Pyrosis

heartburn, water-brash

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Rheumatic disease

screws, springes, rheumatics

Rubella

German measles

Rubeola; morbilli

measles

Scarlatina

scarlet fever

Seizure

convulsion, fit

Strabismus

a squint

Syncope

fainting

Tachycardia

palpitations

Tendonitis

golfer’s elbow, tennis elbow

Tetanus

lockjaw

Tinea circinata

ringworm

Tinnitus

ringing in the ears

Tuberculosis

Urticaria

heat spots, hives, nettle rash

Varicella

chickenpox

Verrucae

warts

Vesicle

blister

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Idioms: parts of the
body

INTRODUCTION

The English language has thousands of idioms. By an ‘idiom’ we
mean a number of words which, when taken together, have a dif-
ferent meaning from that of each separate word.

The reason for including these idioms of parts of the body is

that, although you may never need to use them yourself, you
should be able to recognise them. You may be told by a person
that by the end of the day he is ‘on his knees’ and you must
realise that he is using the word ‘knee’ idiomatically. What he
means is that he is extremely tired after work and feels like
collapsing.

A woman may tell you of her worries and say she has just

managed to ‘keep her head above water’. If you are not familiar
with the idiom, you may think she has tried to save herself from
drowning but, in fact, she means that she is terribly short of
money and is having a struggle to keep out of debt.

Words and phrases connected with parts of the body have also

been included, such as ‘chesty’, ‘throaty’ and ‘to speak through
one’s nose’. It is essential that you understand these.

IDIOMS: PARTS OF THE BODY

Figures 7.1 to 7.3 are provided so you can familiarise yourself
with the words usually used in everyday conversation to describe
parts of the body.

Arm

A shot in the arm: something that does a person good.

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To give one’s right arm (usually with would): to be willing to

make a sacrifice to get something.

To keep someone at arm’s length: to avoid being friendly.
To stand by with folded arms: to do nothing when action seems

necessary.

To welcome someone with open arms: to greet warmly.

Back

To back a horse: to place money on a horse in a race, to bet.

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Jaw

Throat

Navel

Palm

Big toe

Toenail

Penis

Chest

Chin

Cheek

Nose

Eye

Forehead

Mouth

Thumb

Stomach
(meaning abdomen)

Scrotum

Knee

Thigh

Nail

Shin

Nostril

Ear

Eyebrow

Hair

(containing testes)

Fig. 7.1

Parts of the body (male front view). Reproduced with per-

mission from Parkinson, Manual of English for the Overseas Doctor,
5th edn. Churchill Livingstone, 1999.

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To back down: to be less demanding than before; to withdraw

one’s claim.

To back out: to withdraw from.
To back someone or something: to give one’s support.
To be on one’s back: to be ill in bed.
To break one’s back: to overwork.
To do something behind someone’s back: to act deceitfully.
To have one’s back to the wall: to be struggling against great

difficulties.

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143

Head

Neck

Nape

Shoulder

Arm

Back

Waist

Buttocks

Hand

Knee

Toes

Ankle

Heel

Shoulder blade

Spine

Elbow

Hip

Wrist

Fingers

Thigh

Calf

Instep

Foot

Fig. 7.2

Parts of the body (back view). Reproduced with permis-

sion from Parkinson, Manual of English for the Overseas Doctor, 5th
edn. Churchill Livingstone, 1999.

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To put (get, set) someone’s back up: to make someone angry.
To see the back of someone/something: to get rid of someone/

something that is annoying, unpleasant.

To turn one’s back on: to abandon, to refuse to help.

Blood

A young blood: dashing young man.
Bad blood: ill feeling (between people, nations).
Blood is thicker than water: one’s own relations come before all

other people.

His blood is up: he is in a fighting mood.
His blood ran cold in his veins: he was filled with terror.
It is more than flesh and blood can stand: too much for human

beings to endure.

One’s own flesh and blood: one’s own family.
To do something in cold blood: deliberately; when one is not

angry.

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Groin

Armpit

Nipple

Vagina
(used to describe the
vulva or external genitals)

Breasts

Fig. 7.3

Parts of the body (female front view). Reproduced with

permission from Parkinson, Manual of English for the Overseas
Doctor, 5th edn. Churchill Livingstone, 1999.

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To get blood out of a stone: to get pity from someone hard; to

achieve the impossible.

To get someone’s blood up: to provoke someone very much.
To have fresh, new blood: to have new members in a business,

family or society.

To make one’s blood boil: to make one very angry.
To run in the blood: to have an inherited quality.

Bone

A bone of contention: the subject of constant disagreement.
He will never make old bones: will not live to an old age.
To be all skin and bones: very thin.
To be bone dry: completely dry.
To be bone-idle: completely idle, lazy.
To bone up on: to study intensively.
To feel something in one’s bones: to feel quite sure about some-

thing intuitively.

To have a bone to pick with someone: to wish to complain about

something.

To make no bones about doing something: to have no hesitation

in doing something (usually unpleasant).

To work one’s fingers to the bone: to work very hard without

appreciation.

Brain

A brain-child: original idea of a person or group.
A brain drain: movement of trained and qualified workers to

other countries (usually for better conditions).

A brainstorm: cerebral disturbance; a mental aberration.
A brainstorming session: a method of solving problems in which

many people suggest ideas which are then discussed.

A brain-teaser: problem, puzzle.
A brainwave: a sudden inspiration or clever idea.
A scatter-brained person: a careless, forgetful person.

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Brain-fag: mental exhaustion.
Brain fever: encephalitis.
Brainwashing: forcing someone to change his beliefs by use of

extreme mental pressure.

Brainless: foolish, stupid.
Brainy: clever.
To blow one’s brain out: to shoot oneself in the head.
To have something on the brain: to be obsessive about something.
To pick someone’s brains: to find out someone’s good ideas and

use them.

To rack one’s brains: to think very hard; to solve a problem or

remember something.

Breast

To make a clean breast of something: to confess everything.

Brow (forehead), Brows (arch of hair above eyes)

A high-brow: someone interested in intellectual matters and

culture.

A low-brow: someone showing little interest in intellectual matters

and culture.

To browbeat someone into doing something: to intimidate some-

one with severe looks and words, to bully.

To knit one’s brows: to frown.

Cheek

Cheek: disrespectful speech, impudence.
Cheeks: buttocks.
To be cheeky: to be disrespectful, impudent.
To cheek someone: to speak impudently to someone.
To have the cheek to do something: to be bold, rude enough to do

something.

To turn the other cheek: to refuse to retaliate.

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Chest

To be chesty: to have trouble with one’s lungs.
To cock one’s chest: to boast about oneself.
To get something off one’s chest: to free one’s mind by speaking

about something that was troubling one.

Get that across your chest!: Eat that! (usually a large, nourishing

meal). Slang.

To puff one’s chest out: to be proud of oneself.

Chin

A chin: a talk.
Chin up: be brave.
To be up to the chin in work, etc.: to have too much work to do.
To chin: to talk, to gossip.
To have a chin-wag: to talk with friends about unimportant mat-

ters, to chatter.

To keep one’s chin up: to be brave, to be cheerful in the face of

difficulties.

To take something on the chin: to suffer severe difficulties with

courage.

Ears

In at one ear and out at the other: ignored or quickly forgotten

advice.

To be all ears: to listen very carefully.
To be up to one’s ears in: deeply involved or occupied in.
To box someone’s ears: to smack someone on the ears.
To come to one’s ears: to hear a rumour.
To earmark: to put someone/something aside for a special

purpose.

To fall on deaf ears: to pass unnoticed.
To give one’s ears for something: to be prepared to do anything to

get what one desires.

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To have a person’s ear: to have the favourable attention of

someone.

To have a word in someone’s ear: to speak in private.
To keep one’s ear to the ground: to listen carefully.
To play it by ear: to do what seems best at the time.
To prick up one’s ears: to have one’s attention suddenly aroused.
To send someone away with a flea in his ear: to criticise someone

severely so that he goes away unhappily.

To set people by the ears: to cause them to quarrel.
To turn a deaf ear: to ignore, pretend not to hear.

Elbow

Elbow-grease: vigorous polishing; hard physical work.
Elbow-room: plenty of room to move freely.
Out-at-elbows: of a coat, worn out; of a person, poor.
To elbow one’s way through a crowd: to push with one’s elbows.
To raise the elbow: to drink too much.

Eye

A blue-eyed boy: a pet, a favourite.
A sight for sore eyes: someone or something very welcome,

pleasant.

An eye for an eye: to punish those who hurt us.
An eye-opener: an event or piece of news which causes surprise.
An eyesore: a very unpleasant thing to look at.
Eyeball to eyeball: face to face with someone.
Eye contact: looking directly into another person’s eyes.
Eye-opener: an enlightening experience.
Eye-wash: lotion for bathing eyes; words or actions intended to

mislead.

Green-eyed: jealous.
In the eyes of: in the opinion of.
In the mind’s eye: imagining in the mind.
In the public eye: to be watched by the public constantly.

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The apple of one’s eye: someone or something very precious.
To be up to the eyes in work: to have far too much work to do.
To catch someone’s eye: to attract someone’s attention.
To cry one’s eyes out: to weep very much.
To do something with one’s eyes open: to act knowing the results

of the action.

To eye someone: to look at carefully, admiringly, jealously, etc.
To get (or give) a black eye: to receive (or give) a blow on the eye

so that the skin around it goes black.

To give someone the glad eye: to encourage someone to be

amorous.

To have an eye for: to have a liking or ability to do something; to

have good judgement on something.

To have an eye on/to the main chance: to think and work with

one’s own advantage always in view.

To have half an eye on: not to give something one’s full attention.
To have one’s eyes opened: to be forced to see reality.
To keep an eye on someone/something: to watch carefully.
To keep one’s eye open for: to watch carefully.
To keep one’s eyes skinned: to be very watchful.
To make eyes at someone: to look at someone (usually of the

opposite sex) with open admiration and invitation.

To pull the wool over someone’s eyes: to try to hide the truth from

someone.

To run one’s eye over: to look quickly at, to glance at.
To see eye to eye with someone: to agree; to have the same ideas.
To turn a blind eye: to ignore deliberately, pretend not to see.

Face

Face-ache: neuralgia.
Let’s face it: let’s be honest with each other.
To be a slap in the face: a sudden disappointment, rejection.
To face the music: to face criticism/punishment as a result of one’s

own actions.

To face up to something: to meet courageously (usually difficulties).

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To fly in the face of convention, rules, etc.: to defy, disobey

openly.

To have a face as long as a fiddle: to look depressed.
To keep a straight face: not laugh. (Often used negatively, e.g. ‘I

couldn’t keep a straight face’.)

To look someone in the face: to look directly at someone.
To lose face: to be humiliated, to be put to shame.
To make/pull a face: to grimace.
To pull a long face: to look depressed, disappointed, displeased.
To put a brave/good face on it: to behave as if circumstances are

better than they really are.

To put one’s face on: to apply cosmetics to one’s face.
To save one’s face: to try to avoid shaming oneself openly.
To set one’s face against: to oppose.
To show one’s face: to appear, be seen.
To stare one in the face: something that is obvious, clear to see.

Feet – see Foot

Fingers

Not to raise (lift, stir) a finger to help someone: to refuse to be of

any help.

One’s fingers itch to do something: one wishes very much to do

something.

To be all fingers and thumbs: to be clumsy with one’s hands often

due to nervousness.

To be light-fingered: to steal easily.
To burn one’s fingers: to get into trouble by interfering in other

people’s affairs.

To finger: to touch.
To get/pull one’s finger out: to stop being lazy, work harder

(slang).

To have a finger in every pie: to be involved in many activities.
To have butter fingers: to let things slip out of the hands.
To have something at one’s fingertips: to know perfectly.

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To keep one’s fingers crossed (for someone): hope for luck with a

problem or difficulty.

To lay/put one’s finger on something: to realise the most important

aspect of a matter.

To let something slip through one’s fingers: to lose hold of, allow

to escape (usually of opportunities).

To twist a person round one’s finger: to have someone in one’s

power so that they do all one wishes.

Flesh

Flesh wound: one not reaching bone or a vital organ.
One’s own flesh and blood: one’s own family.
Proud flesh: new flesh coming from a wound.
Sins of the flesh: sexual sins.
To be neither fish nor flesh: to be of indefinite character.
To have one’s pound of flesh: to insist cruelly on repayment.
To lose flesh: to get thinner.
To make one’s flesh creep: to be terrified so that one’s skin seems

to move.

To put on flesh: to get fatter.
To see someone in the flesh: actually to see someone.

Foot, feet

My foot!: Nonsense! Rubbish!
Not to let the grass grow under one’s feet: to act quickly when one

has made a decision.

To be on one’s feet: to be in reasonable health; to be standing.
To be run off one’s feet: to be so busy one cannot sit down.
To dog one’s footsteps: to follow one constantly and so cause

irritation.

To drag one’s feet: to be slow to take action.
To fall on one’s feet: to be lucky.
To fall over one’s feet to be kind, helpful, etc.: to make a great

effort to be kind, helpful, etc.

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To find one’s feet: to be comfortably settled in a new job, situa-

tion, etc.

To foot the bill: to pay.
To get cold feet: to be afraid, discouraged.
To go on foot: to walk.
To have one foot in the grave: to be very ill, close to death.
To have one’s feet on the ground: to be practical, sensible.
To have the world at one’s feet: to be very successful.
To put one’s best foot forward: to walk quickly, to work quickly.
To put one’s feet up: to relax, to rest.
To put one’s foot down: to be firm, to protest.
To put one’s foot in it: to do or say something that causes anger,

trouble.

To set someone on his feet: to help, usually with money, to start a

business, etc.

To stand on one’s own feet: to be independent.
To step off on the wrong foot: to start something in the wrong way.

Hair

A hair’s breadth: a very small distance.
Hair-raising (stories): terrifying.
Not turn a hair: to show no sign of fear or emotional upset.
To a hair: exactly (usually of weight).
To get in a person’s hair: to annoy, irritate someone.
To have one’s hair standing on end: to be terrified.
To have someone by the short hairs: to have control over them.
To keep one’s hair on: not to grow angry.
To let down one’s hair: to act freely, to be uninhibited.
To split hairs: to argue about very small, unimportant differences.

Hand

A right-hand man: someone who can be relied on for help and

advice.

At first hand: directly.

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Hands off!: Do not touch.
Hands-on experience: involving active participation.
Never to do a hand’s turn: never make the slightest effort.
To be a handful: to be difficult to control.
To be an old hand at something: to be experienced.
To be hand-in-glove with someone: to be extremely friendly (usu-

ally planning something together).

To be high-handed: to be arrogant.
To be offhand: to be abrupt in manner, casual.
To be off one’s hands: to no longer be responsible for someone

or something.

To be open-handed: to be generous with money.
To be out of hand (of children, a situation, etc.): to be out of

control.

To be underhand: to be deceitful, dishonest, not open.
To eat out of someone’s hand: to do whatever one wishes.
To force someone’s hand: to make someone do something.
To get one’s hand in: to get to know how to do something.
To give/lend someone a hand: to help someone physically.
To give someone a free hand: to allow someone to do as he

wishes.

To hand: to give, to offer.
To have a hand in something: to share in the activity.
To have one’s hands full: to be extremely busy.
To have one’s hands tied: to be unable to act in the way one

wishes.

To have the upper hand over someone: to dominate.
To have time on one’s hands: to have plenty of free time.
To keep one’s hand in: to be in practice.
To lay hands on: to seize, touch (often used negatively).
To live from hand to mouth: to live from day to day; without reg-

ular money.

To play into someone’s hands: to do something which helps one’s

opponent.

To rule with a heavy hand: to rule severely.
To say offhand: to give an answer immediately from memory.

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To take one’s courage in both hands: to force oneself to do some-

thing difficult, unpleasant.

To take someone in hand: to try to improve someone’s

behaviour.

To try one’s hand at something: to make an attempt to do some-

thing new.

To wait on someone hand and foot: to attend to someone’s needs

with great care.

To wash one’s hands of someone/something: to have nothing more

to do with.

Head

A headache: a pain in the head; a difficult problem; a trouble-

some person.

From head to foot/toe: completely; all over the person.
It is on his head: he is responsible for it.
Not to know whether one is standing on one’s head or one’s heels:

to be in a state of extreme confusion.

To be above/over one’s head: too difficult to understand.
To be big-headed: to be conceited.
To be block-headed: to be dull, stupid.
To be fat-headed: to be stupid.
To be hard-headed: to be practical, unsentimental.
To be head and shoulders above others: to be much taller; to be

far better.

To be head over heels in love: completely, very much in love.
To be hot-headed: to be hasty, impulsive.
To be pig-headed: to be obstinate.
To be soft-headed: to be simple-minded.
To be touched in the head: to be slightly mad.
To bite a person’s head off: to speak sharply, angrily to someone.
To bury one’s head in the sand: to avoid facing facts by pretend-

ing not to see them.

To come to a head: to reach a crisis.
To eat one’s head off: to eat an excessive amount.

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To get one’s head down: to go to bed.
To get something into one’s head: be convinced that something

is true.

To go off one’s head: to become crazy, mad.
To go to one’s head: to make one excited, to intoxicate one.
To have a good head for business: to have a natural aptitude for it.
To have a good head-piece: to have plenty of brains.
To have a head: to have a headache, often from drinking too

much.

To have a head like a sieve: to be very forgetful.
To have an old head on young shoulders: to be wise beyond

one’s years.

To have one’s head screwed on the right way: to be intelligent, full

of common sense, especially in practical matters.

To have something hanging over one’s head: to have some danger,

something unpleasant going to happen soon.

To head off: to divert a person from someone or something.
To heap coals of fire on a person’s head: to treat a person well

who has treated oneself badly.

To hit the nail on the head: to guess right, to reach the correct

conclusion.

To keep one’s head: to stay calm in a difficult situation.
To keep one’s head above water: to keep out of debt.
To knock on the head: to destroy, disrupt an idea, plan, etc.
To knock/run one’s head against a stone wall: to do something

that will fail, because of opposition.

To let someone have his head: to let him do as he wishes.
To lose one’s head: to lose one’s self-control in a difficult situation.
To make head, headway: to make progress.
To make head or tail of something: to understand it. (Usually used

negatively, e.g. ‘I couldn’t make head or tail of the letter he
sent me’.)

To put something out of one’s head: to forget it deliberately, to

stop thinking about it.

To put things into someone’s head: to suggest things to him.
To take it into one’s head: to make a sudden decision.

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To talk someone’s head off: to talk so much that the other person

is weary.

Two heads are better than one: two people know more together

than one person alone.

Heart

After one’s own heart: a person sharing one’s own interests,

opinions.

At heart: basically, deep down.
Have a heart!: Be reasonable; don’t be unkind!
Heartache: deep sorrow, grief.
Heartburn: pain in chest as a result of indigestion, pyrosis.
Heart-felt sympathy: deepest sympathy.
Heart-searching: doubts, uncertainties.
In one’s heart of hearts: deep down in oneself.
Not to have the heart to do something: not to have the courage to

do something.

The heart of the matter: the essence, the vital part.
To be downhearted: to be depressed.
To be good at heart: to be good basically.
To be half-hearted about something: not to be very enthusiastic.
To be hard-hearted: to be hard, unkind.
To be heartless: to be unkind, unsympathetic.
To be hearty: to be cheerful.
To be in good heart: to be cheerful, confident.
To be lion-hearted: to be very brave.
To be soft-hearted: to be kind, sympathetic.
To be stout-hearted: to be very brave.
To break one’s heart: to be overwhelmed with sorrow.
To cause heartache: to cause suffering.
To cry one’s heart out: to cry excessively.
To eat one’s heart out: to fret, worry excessively.
To have a big heart: to be warm, generous.
To have a heart: to have trouble with one’s heart.
To have a heart-to-heart talk with someone: to speak openly, hid-

ing nothing.

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To have a hearty appetite: to have a very good appetite.
To have no heart: to be hard, insensitive.
To have no heart for something: to have no enthusiasm for

something.

To have one’s heart in one’s boots: to be depressed, to feel

hopeless.

To have one’s heart in one’s mouth: to be very afraid.
To know/learn/ say by heart: to know/learn/say something word

for word by memory.

To lose heart: to have no hope, to become discouraged. (Often

used negatively, e.g. ‘Don’t lose heart: keep on hoping’.)

To lose one’s heart: to fall in love.
To put one’s heart into something: to do something with

enthusiasm.

To set one’s heart on something: to want something very much.
To take heart: to become more hopeful.
To take someone to one’s heart: to feel deep affection for someone.
To take something to heart: to be upset; to worry too much about

things.

To tear one’s heartstrings: to hurt one very deeply.
Whole-hearted: complete, without doubts.

Heel(s)

A heel: a completely unreliable person.
An/one’s Achilles heel: weak or vulnerable point, especially of

character.

Not to know whether one is standing on one’s head or one’s heels:

to be in a state of extreme confusion.

To be down at heel: poorly dressed and in a state of poverty.
To be head over heels in love: completely, very much.
To bring someone to heel: to put them under control.
To carry with the heels first: as a dead body.
To come on the heels of: to follow immediately.
To kick one’s heels: to stand waiting idly, impatiently.
To leave to cool his heels: to make someone wait deliberately.

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To show a clean pair of heels: to run away.
To take to one’s heels: to run away.

Knee

To be knee-deep in something: deeply involved in.
To be on one’s knees: to kneel, especially when praying; to be

completely exhausted.

To bring someone to his knees: to make him submit, stop fighting.
To go down on one’s knees to someone: to beg for something.
To have a knees-up: a very lively party.

Knuckles

To knuckle down to a job: to work as hard as one can.
To knuckle under: to accept defeat.
To rap someone’s knuckles: to reprimand.

Lap (waist to knees of one sitting)

In the lap of the gods: uncertain future.
In the lap of luxury: in great comfort and luxury.

Leg

A blackleg: a person who continues working when others are on

strike.

Not to have a leg to stand on: have no good reason to support

one’s argument.

The boot is on the other leg: the truth is the opposite of what one

believes.

To be on one’s last legs: to be close to death; utterly weary.
To find one’s legs: to be able to stand and walk (usually after an

illness).

To get one’s sea legs: to become used to the movement of a ship.
To give someone a leg up: to help someone.

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To pull someone’s leg: to tease someone.
To show a leg: to get out of bed.
To stretch one’s legs: to go for a walk.
To walk someone off his legs: to tire him out with walking.

Lip

Lip: impudence, saucy talk.
None of your lip!: ‘Don’t speak to me like that!’
Lip-language, -reading, -speaking: use of the movement of the

lips to and by the deaf and dumb.

A word escapes one’s lips: something is said without thought.
To bite one’s lip: to hide emotion, to stop oneself from saying

something.

To curl one’s lip: to show scorn.
To hang on someone’s lip: to listen with great care.
To have sealed lips: to be silent about something.
To keep a stiff upper lip: to bear troubles without showing

emotion.

To lick one’s lips: to show appreciation of food (or sometimes

other things).

To pay lip service to principles, etc.: to say one believes in some-

thing but not to act accordingly.

Mind

Mind: memory, remembrance.
Mind-blowing: (of drugs, etc.) causing ecstasy, excitement; (of

news) confusing, shattering.

Mind-boggling: astonishing, extraordinary; overwhelming.
Never mind: ‘It doesn’t matter; don’t worry’.
To be not in one’s right mind: to be mad.
To be out of one’s mind: to be mad.
To bear something in mind: to remember.
To bend someone’s mind: to influence the mind so that it is per-

manently affected.

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To give someone a piece of one’s mind: to speak openly and

critically.

To go out of one’s mind: to go mad, e.g. ‘He went out of his mind

in the end’; to be forgotten, e.g. ‘I’m so sorry. It went out of
my mind’.

To have a lot on one’s mind: to be worried about many things.
To have presence of mind: to act and think quickly in

emergencies.

To know one’s own mind: to be definite about what one wants.
To make up one’s mind: to decide.
To mind: (a) To be careful (used very often in orders): ‘Mind the

step’ – be careful of the step; ‘Mind the car’ – get out of the
way of the car. (b) To care (often used negatively): ‘I don’t
mind what she does or says’. (c) To object (used mainly inter-
rogatively and negatively): ‘I don’t mind going to hospital to
have my baby’. Note the polite request: ‘Would you mind’ +
-ing form of the verb: ‘Would you mind lying on the bed?’. (d)
To take care of: ‘She had no one to mind the baby when she
went to work’. Noun: a baby-minder.

To mind one’s own business: not to interfere in the affairs of

other people.

To mind one’s p’s and q’s: to be careful what one says and does.
To mind out for: avoid.
To take a load/weight off someone’s mind: give great relief.

Mouth

Mouth: impudent talk, rudeness.
To be down in the mouth: to be depressed.
To look as if butter would not melt in one’s mouth: to look inno-

cent, incapable of badness.

To make one’s mouth water: to cause saliva to flow at the sight

of food.

To put words into someone’s mouth: to tell someone what to say.
To take the words out of someone’s mouth: to say what someone

was about to say.

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Nail(s)

(Note: Several idioms are listed which refer to other meanings of
the word ‘nail’ than the nail of the body. They have been included
because they are all commonly used and you should be familiar
with them.)

Nail-biting: causing anxiety or tension.
To be as hard as nails: to be very tough; merciless.
To be as right as nails: to be perfectly fit.
To fight tooth and nail: to fight fiercely, vigorously.
To hit the nail on the head: to say the right thing, to guess right.
To nail someone down: to make someone give a definite state-

ment; details.

To pay on the nail: to pay at once.
To put a nail in one’s coffin: to do something that will shorten

one’s life.

Neck

Neck: boldness, disrespect, impertinence.
Neck or nothing: desperately risking everything for success.
Stiff-necked: obstinate, proud, stubborn.
To be a pain in the neck: to be a nuisance and pest to someone.
To be up to the neck in debt, work: to be completely immersed in

debt, work.

To break one’s neck to do something: work extremely hard to do

something.

To get it in the neck: to be severely punished.
To have the neck to do something: to be rude enough to do

something.

To neck: to hug and kiss someone intimately.
To run neck and neck: to be level with someone in a competition.
To save one’s neck: to save oneself from punishment.
To stick one’s neck out: to act or speak in a way which exposes

one to harm or criticism.

To talk out of the back of one’s neck: to talk nonsense.

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To throw someone out neck and crop: to throw someone out head

first, bodily.

Nerve(s)

Nerve-racking: frightening, stressful.
Not to know what nerves are: to have a calm temperament.
To be a bundle of nerves: in a very nervous state.
To get on one’s nerves: to annoy or irritate very much.
To have a fit of nerves: to be in a nervous state.
To have iron/steel nerves: not to be easily upset or frightened.
To have the nerve to do something: to be brave, to be impudent

enough.

To lose one’s nerve: to become frightened and unsure of oneself.
To nerve oneself to do something: to use all one’s strength, mental

and physical.

To strain every nerve: to make a great effort.
What a nerve!: What impudence!

Nose

To cut off one’s nose to spite one’s face: to do something in anger

to hurt someone else which also hurts oneself.

To follow one’s nose: to go straight on, to act on instinct.
To get up a person’s nose: to annoy someone.
To have a good nose: to have a good sense of smell.
To keep one’s nose to the grindstone: to work hard over a long

period.

To lead someone by the nose: to make someone do anything one

wishes.

To look down one’s nose at someone: to regard someone as

inferior.

To nose about: to look enquiringly everywhere.
To pay through the nose: to pay an excessive price.
To poke one’s nose into something: to try to find out about people

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and things which do not concern one.

To put someone’s nose out of joint: to do something to irritate or

upset someone.

To see no further than one’s nose: not to be able to imagine the

future or any situation other than the current one.

To speak through one’s nose: to speak with a nasal sound (often

as a result of adenoids).

To turn up one’s nose: to show dislike or disapproval.

Palm

To grease someone’s palm: to bribe him, offer money for informa-

tion, etc.

To palm something off on someone: to sell something that is

worthless or damaged.

Shoulder

A shoulder to cry on: someone who listens to one’s problems

with sympathy.

Shoulder to shoulder: with united effort.
Straight from the shoulder: a strong blow or strong criticism of

someone.

To cold-shoulder someone: to ignore someone deliberately; treat

coldly.

To have a chip on one’s shoulder: to go around with a sense of

grievance.

To have an old head on young shoulders: a young person who is

wise beyond his age.

To have broad shoulders: to be strong; to be able to bear

responsibility.

To put one’s shoulder to the wheel: to make a great effort to do

something.

To rub shoulders with: to mix with people.
To shoulder (a burden or the blame): to carry.

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Skin

A skinflint: a mean, miserly person.
A skinhead: a member of a group of young people who have

closely cut hair, strange clothes and are often violent.

Skin-deep (of beauty, emotion, wound): no deeper than the skin,

not lasting, on the surface.

To be skin and bone: very thin.
To be thick-skinned: not to care what others say about one,

insensitive.

To be thin-skinned: to be too sensitive to what others say.
To escape by the skin of one’s teeth: to have a narrow escape.
To get under one’s skin: to annoy intensely, to hold one’s interest

very much.

To jump out of one’s skin: to be startled, frightened suddenly.
To keep one’s eyes skinned: to be watchful.
To save one’s skin: to avoid or escape from danger.
To skin: for a wound to be covered with new skin; to remove skin

from something.

Skull

Thick-skulled: dull, stupid person.
To get something into one’s skull: to understand and remember it.

Stomach

To have a strong stomach: ability not to feel nausea; can eat

anything.

To have butterflies in the stomach: to have fluttery feelings in the

stomach due to nervousness.

To stomach something: accept. (Usually in negative form, e.g. ‘He

cannot stomach her ways’, meaning he cannot bear them.)

To turn one’s stomach: cause nausea; cause someone to be

disgusted.

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Teeth – see Tooth

Throat

Cut-throat competition: fierce, intense struggle in business.
Throaty: guttural, spoken in the throat.
To cut one’s own throat: to act in a way that harms oneself; to kill

oneself.

To have a frog in one’s throat: hoarseness or loss of voice.
To have a lump in one’s throat: to feel choked with emotion so

that one can hardly speak.

To have a throat: to have a sore throat.
To have words stick in one’s throat: to be too embarrassed by

something to be able to speak of it.

To jump down someone’s throat: to speak angrily to someone.
To thrust something down someone’s throat: to try to make some-

one accept one’s own beliefs, views, etc.

Thumb

Thumbs up!: mark of victory, satisfaction.
To be under someone’s thumb: to be dominated by someone.
To thumb a lift: to sign with the thumb to ask a motorist for a

free lift.

To twiddle one’s thumbs: to have to sit still and do nothing.

Toe(s)

From top to toe: from head to foot, completely.
To be on one’s toes: to be ready for action, alert.
To step/tread on someone’s toes: to annoy someone unwittingly

(often by doing what they want to do).

To tiptoe: to walk on the tips of one’s toes; to walk quietly.
To toe the line: to obey the rules, of a party, society, etc.
To turn up one’s toes: to die.

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Tongue

A slip of the tongue: a mistake made when speaking.
Tongue: language (e.g. one’s mother tongue, meaning one’s

native language).

To be tongue-tied: to be too shy, too nervous to speak.
To have a dangerous tongue: to speak maliciously.
To have a long tongue: to be talkative.
To have a ready tongue: to speak easily, fluently.
To have something on the tip of one’s tongue: to be about to say

something and then forget it.

To hold one’s tongue: to be silent.
To lose one’s tongue: to be too shy to speak.
To put out one’s tongue: grimace to mark displeasure; for doctor’s

inspection.

To speak with one’s tongue in one’s cheek: to say something that

is not true in order to joke with someone.

To wag one’s tongue: to talk indiscreetly, to gossip.

Tooth, teeth

In the teeth of evidence, opposition, wind, etc.: against it.
Teething troubles: difficulties in the first stages of something.
To be armed to the teeth: to be fully armed with many weapons.
To be fed up to the back teeth with something: to be bored by,

tired of.

To be long in the tooth: to be old.
To cast something in someone’s teeth: to blame him for it.
To cut a tooth: a new tooth begins to show above the gum (of

babies and children).

To cut one’s eye-teeth: to gain worldly wisdom, maturity.
To cut one’s wisdom teeth: (as to cut one’s eye-teeth).
To escape by the skin of one’s teeth: to have a narrow escape.
To fight tooth and nail: to fight with all one’s strength.
To get one’s teeth into something: to make an enthusiastic start on

a job, etc.

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To have a sweet tooth: to enjoy eating sweet things.
To set one’s teeth on edge: to cause an unpleasant feeling in the

teeth; to cause disgust.

To show one’s teeth: to become aggressive.
To take the bit between one’s teeth: to reject the advice and con-

trol of others.

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Phrasal verbs

INTRODUCTION

‘Phrasal verb’ is a name given to those combinations of verb plus
preposition or adverbial particle from which we have now hun-
dreds of phrases to describe everyday events and activities.

The most commonly used phrasal verbs are formed from the

shortest and simplest verbs in the English language such as come,
do, get, go, make, put, take, followed by words such as down,
from, in, out, up, to. A phrasal verb consists of two (sometimes
three) parts and it is essential to consider the parts together, for
the combination often makes a different meaning. Some phrasal
verbs have several meanings.

Those who study the English language as a second language

have great difficulty in understanding and using phrasal verbs
correctly. For this reason a whole chapter is given to them. It is
quite impossible to follow everyday speech without a knowl-
edge of phrasal verbs, because we use them in preference to
more formal words. To take some examples: we talk about ‘get-
ting up’ in the morning and ‘putting on our clothes’ rather than
‘rising’ and ‘dressing’.

Nurses, doctors and other health workers must use language

understood easily by their patients, so they ask, for example,
‘When did the pain first come on?’ meaning the onset of pain, or
say ‘I want you to cut down on fatty foods’, meaning to reduce
intake. The examples given here are mostly taken from healthcare
situations and so will be invaluable to you.

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BREAK

— Break down:

i. collapse mentally or physically, often due to stress. Nurse

Foster worked too many double shifts and eventually her
health broke down.

ii. cry with grief, shock, etc. If I talk about losing my baby, I

break down.

iii. fail to work because of electrical, mechanical, etc., fault.

The cardiac imaging system has broken down.

iv. fail, discontinue. Negotiations over the ambulance work-

ers’ pay dispute have broken down.

— Break in: enter somewhere by force. I could never sleep alone

in the house after burglars broke in.

— Break out: sudden start of disease, fire, violence, war. Food

poisoning broke out in the care home.

— Break out in something: suddenly become covered in. (a)

Whenever I eat strawberries I break out in a rash. (b) I keep
waking up and breaking out in a cold sweat.

— Break through: make a major discovery or advance. The

pharmaceutical company hopes to break through with a new
treatment for Alzheimer’s disease.

— Break up: deteriorate (of health). He’s breaking up under the

strain of nursing his wife.

— Break something up: come to end (of relationships). I’ve

been ill ever since my marriage broke up.

— Break with: end relations with someone. My son has broken

with us since he mixed with this group.

BRING

— Bring something about: cause something to happen. Drug

misuse brought about his death.

— Bring something back: call to mind. Talking to you brings

back memories of my childhood.

— Bring someone back to something: restore. A complete

change will bring you back to health.

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— Bring someone down: defeat, degrade. Heavy drinking

brought him down.

— Bring something down: lower, reduce. Reducing your

weight will help to bring down the cholesterol levels in your
blood.

— Bring something on: cause. It would help me to know what

brings on your chest pain.

— Bring someone round: restore to consciousness. The patient

was brought round by mouth-to-mouth ventilation.

— Bring someone through: save someone’s life. Her husband

was critically ill but the doctors and nurses struggled all night
to bring him through and he survived.

— Bring someone to: restore to consciousness.
— Bring someone up: rear, teach a child social habits (often

used in the passive). His mother died when he was two so he
was brought up by his grandmother. (Note: To be well brought
up. To be badly brought up.)

— Bring something up:

i. vomit. She’s not well. She brought up her lunch today.
ii. eructation. Do you bring any wind up?

COME

— Come about: happen. How did the accident come about? He

slipped on a wet floor.

— Come across: make an impression of a particular kind. She

comes across as a very nervous woman.

— Come across someone/something: find, meet or see unex-

pectedly. I’ve never come across such a bad case of shingles
before.

— Come along: make progress. You’re coming along nicely. We

shall have you walking without crutches next week.

— Come back: return. (a) Make an appointment to come back

in a month. (b) The stress symptoms have come back since I
went back to work.

— Come back to someone: return to memory. Yes, what hap-

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pened is all coming back to me now. I remember falling down
the steps.

— Come by something: get, obtain. How did you come by that

scar on your cheek? I was in a fight and someone threw a bot-
tle at me.

— Come down (of prices, temperature, etc.): be lowered, fall.

Your blood pressure has come down since we started you on
the tablets.

— Come down on someone: criticise someone, punish. The

police come down heavily on people found with class A
drugs.

— Come down with something: become ill with something. She

came down with flu and was unable to keep her appointment.

— Come forward: present oneself, with help, information, etc.

Will anyone who saw the accident please come forward?

— Come from: have as one’s birthplace (not used in the contin-

uous tenses). Where do you come from? I come from India.

— Come in:

i. be admitted to hospital. We’d like your mother to come in

so we can do one or two tests.

ii. be introduced, begin to be used. More people were treated

quicker and better when day surgery and keyhole surgery
came in.

— Come off something: fall from a bicycle, horse, etc. My son

came off his motor bike and broke his left leg.

— Come on:

i. encourage someone to hurry, make an effort, try harder

(used in imperative only). Come on Mr Hopkins. Let’s see
you walk across the room now.

ii. grow, make progress. Good. Your baby’s coming on very

well.

iii. start (of symptoms, etc.) Tell me exactly when these panic

attacks first came on.

— Come out:

i. be published. When’s your new book coming out?
ii. become known. It’s just come out that they are closing

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down the factory and I shall lose my job.

iii. publicly acknowledge one’s homosexuality. John and

Simon have come out.

iv. stop work, strike. Do you think health professionals should

come out for better working conditions?

— Come out in something: be partially covered in rash, spots,

etc. Her hands came out in a rash after she used a new
detergent.

— Come over: begin to feel dizzy, faint, etc. It’s happened twice

now travelling home from work. I came over faint.

— Come round: regain consciousness. Your son hasn’t come

round yet from the anaesthetic.

— Come through something: recover from a serious illness,

accident, survive. You’re lucky to have come through such a
terrible accident.

— Come to: regain consciousness. When I came to, I was on the

bathroom floor.

— Come under something: be classified as. Diamorphine and

cocaine come under Class A of the Misuse of Drugs Act.

— Come up:

i. arise (of a subject). The question of the rights of patients

is always coming up these days.

ii. happen, occur. I’m afraid I shall be late for my clinic.

Something urgent has come up.

CUT

— Cut back (on) something: reduce expenditure. Because of

financial restrictions, all departments have had to cut back
drastically.

— Cut something down; cut down (on something): reduce

amount or quantity. (a) I’ve already cut my cigarettes down to
10 a day. (b) You should cut down on the fats you eat.

— Cut someone off: break the connection on the telephone

(often used in passive). How annoying. I’ve just been cut off
in the middle of a conversation.

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— Cut something off:

i. amputate, remove. Following the explosion, the man had

to have his left leg cut off.

ii. stop the supply of something (often used in passive). The

electricity has been cut off.

— Cut off: isolated. She feels very cut off since she got cancer.
— Cut out something:

i. excise. I had a lump on my neck cut out.
ii. stop eating, using. I’ve cut out alcohol completely.

— Cut someone up: upset emotionally (usually in the passive).

He was terribly cut up by his wife’s death.

— Do away with oneself: to commit suicide, kill oneself. I feel

so depressed, Nurse. I could do away with myself.

— Do someone in:

i. exhaust (usually in passive). At the end of the week I’m

absolutely done in.

ii. kill (usually in passive). The old man was done in (slang).

— Do something in: injure a part of the body. He did his back

in moving furniture.

— Do something to something: cause something to happen

(questions often start with what). What have you done to your
leg? It’s bleeding.

— Do something up:

i. fasten with buttons or zip, etc. Well, Mr Cox, let’s see if

you can do up your clothes.

ii. modernise, redecorate, restore. These wards are depress-

ing. They need doing up.

— Do with something:

i. be concerned with, connected with (use with have to). His

job has something to do with nursing research.

ii. need, wish for (used with can and could). You could do

with some new glasses. Go and have your eyes tested.

— Do without someone/something: manage without. We’ve

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had to do without a speech and language therapist since the
last one left.

FIND

— Find something out: discover the truth, learn some informa-

tion. When did you find out your son was on drugs?

FIT

— Fit someone/something in: manage to find time to see some-

one or do something. The nurse is booked up all morning, but
as it’s urgent I’ll try and fit you in.

— Fit in with someone/something: suit, harmonise with some-

one/something. Do you think she will fit in with the rest of the
team?

— Fit someone/something out/up with: equip. After the oper-

ation, we’ll fit you up with a seat to get you into the bath.

GET

— Get about:

i. move from place to place. I can’t get about much now that

I’ve got arthritis.

ii. spread (of news, rumour). It got about that the

Community Hospital might close.

— Get something across: communicate something to someone.

It’s quite difficult to get across to my mother that she can’t go
on living alone.

— Get along: make progress. Fine. You’re getting along very

well.

— Get along with someone: have a good relationship with

somebody. Do you get along with your family?

— Get around: — as for Get about.
— Get at someone: criticise someone repeatedly (usually in con-

tinuous tenses). The other children are always getting at him

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and he’s afraid of going to school now.

— Get at someone/something:

i. reach. Make sure you put these tablets somewhere where

the children can’t get at them.

ii. mean, try to say. I’m not sure what you’re getting at.

— Get away: have a holiday. You should try to get away for a

few days after the operation.

— Get back: arrive, return home. He says he can get back under

his own steam (without help).

— Get back to someone: contact someone again later. I don’t

have the information you need just now, but I’ll get back to you.

— Get something back: recover something that was lost. He’s

now got back the use of his arm which was paralysed by the
stroke.

— Get by: manage, cope with life. Lone-parent families often

have a struggle to get by.

— Get someone down: depress. All this quarrelling in the family

gets me down.

— Get something down: swallow (with difficulty). The tablets

you gave me last time were so big I could hardly get them
down.

— Get into: start bad habits. How did she get into drugs?
— Get (someone) off: fall asleep, help someone to fall asleep. It

takes me ages to get the baby off at night.

— Get off something: leave work with permission. He got a

week off when his wife had a baby.

— Get on:

i. perform (often used in questions with how). (a) How did

you get on in the exam? (b) I got on fine with my first
assignment but failed my second.

ii. progress. Take these tablets for a month and we’ll see

how you get on.

— Get on with someone: have a good relationship with. I get on

fine with my children, but I don’t get on with my wife.

— Get out: leave the house. You must try to get out more. No

wonder you are depressed, sitting here alone all day.

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— Get out of something:

i. escape the necessity or duty to do something. He managed

to get out of working nights for a month.

ii. give up a habit. I wish I could get out of the habit of

smoking after every meal.

— Get over something:

i. overcome. No need to worry. I’m sure we can get over

that problem.

ii. recover from disappointment, illness, shock. He’s getting

over the shock of losing his wife extremely well.

— Get something over: complete something difficult or unpleas-

ant. Thank goodness I’ve got the hysterectomy over.

— Get something over to someone: make someone under-

stand. You must get over to your husband the importance of
remaining active as far as possible.

— Get through something:

i. consume, use a certain amount. He gets through a bottle

of spirits a day.

ii. pass an exam, test. Marvellous. I’ve got through my driv-

ing test.

— Get through to someone:

i. make contact, communicate. We are in despair. We just

can’t get through to our son at all.

ii. reach, especially by telephone. I’ve tried six times to speak

to the stoma care nurse, but I can’t get through.

— Get together: assemble, meet. The management and the union

should get together to settle this problem.

— Get up: rise from bed. Do you have to get up in the night to

pass water?

— Get up to something: do something surprising or unaccept-

able. My parents have no idea what I get up to.

GIVE

— Give something back to someone: restore, return. The

operation should give you back the use of your legs.

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— Give in (to someone/something): stop arguing, fighting,

trying, etc. Mrs Spearey was marvellous. She had so much ill-
ness but she would not give in.

— Give out:

i. come to an end (of food supplies, strength, etc.). I can’t

go on any longer. My strength has given out.

ii. fail, stop working. At the end of the 6-hour operation, the

patient’s heart gave out and he died.

— Give something out: distribute. Those leaflets must be given

out to all staff explaining the new safety regulations.

— Give someone up:

i. renounce hope. The doctors had given her up months

ago, but she made a marvellous recovery.

ii. stop having a relationship with someone. Why don’t you

give him up if he treats you so badly?

— Give something up: stop doing something. (a) How can I give

up smoking? (b) I used to be a teacher, but I gave it up last
year.

— Go against something: conflict with something. Private med-

icine goes against the principles of the NHS set up in 1948.

— Go ahead with something: proceed with something. I’ve

decided I want to go ahead with the job application.

— Go along with someone/something:

i. accompany. Nurse, go along with Mrs Hooper to the

X-Ray Department, will you?

ii. agree. I can’t go along with your idea of a further

operation.

— Go at someone: attack physically or verbally. I was walking

down the street and a young man went at me, knocked me to
the ground and took my bag.

— Go back: return. I want you to go back to your GP with this

letter.

— Go by: pass (of time). As time goes by, you’ll get more used

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to wearing the artificial limb.

— Go by something: form an opinion. I know I look well, but

that’s nothing to go by. I feel terrible.

— Go down:

i. be swallowed (of food and drink). My food won’t go

down (i.e. I have difficulty swallowing food).

ii. be reduced in size, level, etc. How’s your ankle? Well, the

swelling has gone down, but it’s still very painful.

iii. become lower, fall (of prices, temperature, weight, etc.) (a)

His temperature has gone down. (b) I used to be 9 stone
7 pounds, but then I lost my appetite and went down to
8½ stones.

iv. decrease in quality, deteriorate. Standards of behaviour

have gone down in recent years.

— Go down with something: become ill with something. All the

children have gone down with measles.

— Go for someone: attack physically or verbally. He went for

her with a knife.

— Go for someone/something: Fetch. Go for Sister, quickly.
— Go in for:

i. enter for an examination. Thousands of nurses go in for

higher degrees every year.

ii. study for a particular profession. Are you going in for

medicine like your mother?

— Go into something: investigate. The Neonatal Intensive Care

Unit has been closed while the authorities go into the sudden
deaths of ten babies.

— Go off:

i. deteriorate, get worse. Her work has gone off since the

accident.

ii. explode. She had to have plastic surgery after an oil heater

went off in her face.

iii. faint, fall asleep, lose consciousness. (a) If he sees blood,

he goes off. (b) It takes me ages to go off. Sometimes I
take a sleeping pill.

iv. go bad (of food or drink), become unfit to eat or drink.

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The food poisoning was caused by eating some meat that
had gone off.

v. stop (of pain). I’ve had this abdominal pain for a month.

When I take the tablets it goes off, but it comes back.

— Go off someone/something: to lose one’s liking or taste for

someone/something. (a) My wife’s gone off me. (Usually means
does not wish to continue sexual relationship.) (b) I’ve gone off
drink since my operation. (c) I’ve gone off my food completely.

— Go on:

i. continue. (a) This trouble with your bowels has been

going on for years, hasn’t it? (When followed by a verb,
the verb is in the -ing form.) (b) Go on taking the tablets.
(c) Should I go on working while I’m pregnant, Sister? It
is often used negatively: (d) I can’t go on any longer like
this. Can you give me something to help me, Nurse?

ii. happen, take place. What’s going on?

— Go on something:

i. begin to receive payments from the State because of unem-

ployment. We’ve had to go on Social Security as we’ve no
other money coming in.

ii. go on the pill; begin to take the contraceptive pill. When

did you first go on the pill?

— Go on at someone: to complain of someone’s behaviour,

work, etc. He never stops going on at me.

— Go out:

i. be extinguished (of fire, light, etc.). All the lights have

gone out.

ii. leave the house. (a) I’m longing to go out again. (b) You

should be able to go out in a couple of days.

— Go over something: check, inspect details, repeat. Well, I’ve

told you what the treatment involves and I’m going to go over
it again to make sure you understand.

— Go round: spread from person to person (of illness). There’s a

nasty virus going round at the moment.

— Go round to: pay a visit locally. I went round to see the prac-

tice nurse last week and he sent me here.

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— Go through: endure, experience, suffer. (a) When did he go

through the phase of passing loose stools? (b) She’s gone
through a very bad patch recently (an unhappy or difficult
time). (c) I can’t tell you what I’ve gone through since my hus-
band died.

— Go under:

i. have an anaesthetic. The patient went under at 12 and

came round at 4 o’clock.

ii. die (slang). Do you think he’s going to go under?

— Go up: rise (of blood pressure, temperature, etc.). Your blood

pressure has gone up again.

— Go with someone: accompany. Have you anyone who can

go with you to hospital?

— Go without something: manage without something. (a) I

have to go without food before I have the barium enema. (b)
They went without sleep for several days.

KEEP

— Keep away from someone/something: avoid being near to.

Keep away from anyone with German measles if you think
you are pregnant.

— Keep someone/something back: hold back. (a) My disabil-

ity will never keep me back. (b) She couldn’t keep back her
tears.

— Keep someone down: dominate, oppress. They had a difficult

childhood. Their father kept them down.

— Keep something down:

i. keep something in the stomach (often used negatively

meaning to vomit). She’s so thin because she can’t keep
anything down.

ii. not increase something (e.g. wages, prices, weight, etc.).

(a) Keep your weight down. (b) Restricting salt in the diet
may help keep blood pressure down.

— Keep someone from doing something: prevent. All this

coughing keeps me from sleeping.

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— Keep off something: not drink, eat, smoke, etc. (a) Keep off

fatty foods. (b) You should keep off alcohol while you’re tak-
ing these tablets.

— Keep on doing something: continue doing something, do

something repeatedly. The majority of women in the UK keep
on working nowadays. (Note: ‘keep doing something’ has the
same meaning as ‘keep on doing something’.) Michael keeps
getting stomach cramps.

— Keep to something: adhere to an agreement, a course, a diet,

etc. Keep to the diet for another 2 months and then we’ll see
how you are.

— Keep someone up: prevent someone from going to bed. The

baby kept us up all night with his crying.

— Keep one’s spirits, strength up: not allow to fall. (a) She is

a very brave woman and always keeps her spirits up. (Remains
cheerful.) (b) You must eat to keep your strength up.

— Keep up with someone/something: move, progress at the

same rate. Older people find it difficult to keep up with all the
changes of modern life.

LET

— Let someone down: disappoint, fail to help. I can’t leave the

course. I can’t let my parents down.

— Let up:

i. become less intense, severe. If only this pain would let up

for a while.

ii. relax one’s efforts. After the train crash, the team at the

hospital worked night and day to treat the injured. Finally,
they were able to let up a little.

LOOK

— Look after oneself/someone: take care of. (a) She is old and

frail and needs to be properly looked after. (b) Who will look
after your children when you come into hospital?

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— Look after something: be responsible for. The technicians

look after the equipment and keep it in good order.

— Look at something: examine carefully. I want to look at your

ear to see what’s causing the trouble.

— Look down on someone/something: feel superior. Her hus-

band looks down on her because she hasn’t been to university.

— Look forward to doing something: think of something in the

future with pleasure. I’m looking forward to having this plas-
ter cast off.

— Look in: make a short visit to someone’s house. The social

worker will look in again next week.

— Look into something: investigate. We must look into this

complaint. It says someone was left lying on a trolley in the
corridor for several hours without being attended to.

— Look on: watch something without taking part. Whilst the sur-

geon performed the delicate operation, doctors from many
countries looked on.

— Look on someone/something: consider. He’s looked on as

one of the leading nurses in this field.

— Look out: be careful, watch out. Look out! You’ll burn your-

self on that stove.

— Look out for someone/something: watch carefully for

someone/something. When assessing people, nurses look out
for signs that indicate a problem.

— Look over: inspect buildings, papers, etc. Can you look over

this report before I submit it to the Working Party?

— Look through something: examine papers quickly. I’ll just

look through the notes before seeing Ms Turner.

— Look to someone/something: take care of. The child-minder

looks to the children while I’m at work.

— Look up:

i. improve. How’s Mrs Cox? Oh, she’s looking up.
ii. raise eyes. Open your eyes now and look up. I’m going to

put some drops in your eyes.

— Look someone up: visit someone, especially after a long time

apart. Do look me up when you next come to Birmingham.

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— Look something up: search for a word, fact in a reference

book. If you don’t understand the colloquial English your
patient uses, look it up in the Manual.

— Look up to someone: admire, respect. Young boys like to

look up to pop stars and footballers.

MAKE

— Make something of someone/something: understand the

nature or meaning of someone/something. (a) We don’t know
what to make of this change in her behaviour. (b) What do
you make of it all?

— Make off with something: to steal something and run away

with it. The youth made off with the CDs he’d found.

— Make someone out: understand someone’s behaviour. We

just can’t make Mary out at all. She’s changed so much since
she left home.

— Make something out:

i. manage to read. Can you make out what this letter says?
ii. manage to understand. We’ll have to get an interpreter.

We just can’t make out what this person says.

iii. write a cheque, a prescription, etc. The nurse specialist

made out a prescription for my asthma.

— Make up: apply cosmetics. Whenever I make up, I come out

in a rash all over my face.

— Make something up:

i. invent a story, especially to deceive someone. Stop making

things up. What really happened?

ii. prepare a bed. Keep Mr Derby here. The bed hasn’t been

made up yet.

iii. prepare medicine. Take this prescription to the pharmacist

and he’ll make it up for you.

iv. supply deficiency. It’s not harmful to be a blood donor. The

loss of blood is made up quite quickly in a healthy person.

— Make up for something: compensate. No amount of money

can make up for the loss of her husband.

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PUT

— Put something aside: save money, etc., for future use.

Everything costs so much these days. I can’t put anything aside
for my old age.

— Put someone away: to confine someone to prison or psychi-

atric unit (often used in passive). (a) The old man began to
wander in the street at night so his family put him away. (b)
He was put away for life for murder.

— Put something away: save money for future use.
— Put something back:

i. drink large amount of alcohol (slang). He must have put

back a lot of beer to be in this state.

ii. impede. The accident has put back his hopes of running

in the Olympics.

— Put something by: save money for future use. Have you any-

thing put by?

— Put something down:

i. kill animal because it is suffering or sick. I had to have my

dog put down last week.

ii. place a baby in bed. I put him down at 9 and he starts

crying at 11.

iii. write down. I’d better put down when to take the tablets

or I shall forget.

— Put something down to: consider something is caused by.

What do you put this rash down to, Nurse? I put it down to an
allergy.

— Put something forward: propose, suggest. At the meeting it

was put forward that more operations should be dealt with in
the Day Surgery Unit.

— Put something in:

i. install. We aim to put strategies in that will reduce deaths

from cancers by at least a fifth in people under 75 years
by 2010.

ii. spend time on work. Health professionals often put in

many extra hours at work.

— Put in for something: apply for a job. He’s put in for over 20

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G-grade jobs without any success.

— Put someone off (something): disturb, upset. (a) She could

never be a nurse. She’s easily put off by the sight of blood.
(b) Food just puts me off at the moment.

— Put someone off doing something: dissuade someone from

doing something. My parents tried to put me off living with
Tom, but I took no notice.

— Put something off: delay, postpone. The operation had to be

put off because there was no bed available in the ICU.

— Put something on:

i. get dressed. You can put your clothes on now, Mrs Turner.
ii. increase weight. Good. You’ve put on 6 pounds since we

last saw you.

Put someone out:
i. anaesthetise. They put me out and I came round 3 hours

later (slang).

ii. annoy, upset. She was put out because her doctor didn’t

explain what the procedure involved.

— Put something out:

i. dislocate. I think you’ve put your shoulder out and we

must X-ray it to be sure.

ii. extinguish fire, light. Fire crews soon put the fire out.

— Put someone through: connect on telephone. Put me through

to A&E will you please?

— Put someone up: provide a bed and food. I lost my job and

my home. A friend put me up for a few weeks, but I’m home-
less again.

— Put something up:

i. increase price. My landlord has put the rent up by £20 a

week so I’ll have to go.

ii. raise. The pain’s so bad I can’t put my arms up to do my

hair.

— Put up with someone/something: bear, tolerate. (a) I’m

afraid there’s not much they can do about this condition. I’ll
have to put up with it. (b) How did she put up with that vio-
lent husband for so long?

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RUN

— Run across someone/something: to meet someone or find

something by chance. I’ve never run across this before. I think
it’s a case of botulism.

— Run away from someone/something: suddenly leave,

escape. He’s always been a difficult child. He ran away from
home at the age of 10.

— Run someone/something down:

i. hit and knock to the ground. The cyclist was run down by

a lorry.

ii. speak badly about someone. He’s always running down his

girlfriend in public.

— Run someone in: arrest and take to police station. He was

run in for shoplifting (slang).

— Run into something:

i. collide or crash into. A man has just been brought into

A&E. He ran his car into a wall in the fog.

ii. get into danger, debt, trouble, etc. We’ve run into debt and

my partner’s drinking heavily.

— Run something off: make copies on a machine. Could you

run off 20 copies of this hand-out, please?

— Run out of something: come to an end (of permits, supplies,

time, etc.). (a) Make sure we’ve enough clean sheets this
weekend. We mustn’t run out. (b) I’m nearly 85 you know. I’m
running out of time. (c) My energy is running out.

— Run over someone: (of a vehicle) knock someone down and

pass over body. He’s been run over and has multiple injuries.

— Run over something: read quickly, repeat. Will you just run

over the facts again?

— Run through something:

i. discuss, examine, read quickly. I’ve run through the

names of people admitted this week, but your son’s is not
there.

ii. spend carelessly, wastefully They have run through thou-

sands of pounds on advertising.

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iii. use up. We run through a lot of disposable gloves in the

sexual health clinic.

— Run up something: accumulate bills. Why did you run up

such large bills?

SEND

— Send for someone: tell someone to come. He’s failing. Send

for the ambulance.

— Send for something: order something to be delivered. Send

for the latest information, will you please?

— Send off something: post. Don’t forget to send off those let-

ters today.

SET

— Set aside something:

i. save money for particular purpose. She sets aside a bit of

money every month to pay her fuel bills.

ii. keep time for a particular purpose. You must set aside half

an hour a day to practise the relaxation exercises.

— Set back someone/something: delay progress of someone/

something. (a) Mr Deakin was making a good recovery after
his operation, but unfortunately a wound infection has set him
back. (b) Work on the new theatre has been set back 3 months.

— Set in: begin and seem likely to continue (of infection, rain,

winter, etc.). (a) When cold weather sets in, older people must
take precautions to care for themselves. (b) You can see gan-
grene has set in to your left leg and, as it has not responded
to treatment, we have no alternative but to remove it.

— Set on someone: attack. I got this bite when a dog set on me.
— Set someone up: make better, healthier. A week by the sea

will set you up after the bowel surgery.

TAKE

— Take after someone: resemble in appearance or character.

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I’m worried about Jane. She’s so different from me. She takes
after her father.

— Take something away:

i. cause a feeling, etc., to disappear. (a) I’ll give you some

tablets to take the pain away. (b) All this worry has taken
my appetite away.

ii. remove. They’ve taken her womb away.

— Take someone away from someone/something: remove.

When sexual abuse was suspected, the children were taken
away from their parents on the recommendation of social
workers.

— Take something down: record, write something. Can you

take down the details?

— Take something in: absorb, understand by listening or read-

ing. He was so confused he could not take in what the nurse
was saying.

— Take something off:

i. amputate part of body. His left arm had to be taken off

below the elbow.

ii. have time away from work for special purpose. I’m taking

next week off to be at home when my wife comes out of
hospital.

iii. lose weight by dieting. I’m overweight. I want to take off a

stone.

iv. remove part of clothing. You needn’t take off all your

clothes. Just your shirt.

— Take on something: agree to do work, have responsibility.

Don’t take on too much for the next 6 weeks.

— Take something out: remove or extract. (a) I must have this

tooth taken out. It’s giving me a lot of pain. (b) She’s going
into hospital to have her appendix taken out. (c) We’re going
to take the stitches out tomorrow.

— Take something over from someone: take control, respon-

sibility from someone else. Can you take over my bleep for
10 minutes while I see Mrs Briggs?

— Take to someone: develop a liking for someone. I never took

PHRASAL VERBS

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to my daughter-in-law. She’s caused so much trouble in the
family.

— Take to something/doing something: begin to do something

as a habit. (a) We need help. Our only daughter has taken to
drugs. (b) He’s taken to going for long walks late at night.

— Take up something:

i. absorb, occupy time. Nursing takes up all his time and

energy.

ii. start a job. We expect you to take up your duties on 1st

January.

iii. start a profession, hobby, etc. He’s thinking of taking up

mental health nursing as a career.

TURN

— Turn against someone: become hostile to. After our divorce,

my wife tried to turn the children against me.

— Turn someone away: refuse to give help. Health professionals

cannot turn sick people away.

— Turn someone/something down:

i. reject an idea, person, proposal. They turned me down as

a pilot because of my eyesight.

ii. reduce volume of gas, sound, etc. When they turn down

the television I can’t hear a thing.

— Turn in:

i. go to bed (slang). It’s usually 2 o’clock before I turn in.
ii. be pigeon-toed. He walks with his toes turned in.

— Turn something in: stop doing something (slang). The job

was ruining my health so, although I loved it, I had to turn it
in.

— Turn someone off: cause someone to be disgusted by some-

thing or not sexually attracted to someone. His drinking and
bad breath turned me off.

— Turn something off:

i. stop the flow of electricity, gas, etc. Don’t forget to turn off

the machine before you leave the building.

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ii. stop radio, TV. The TV is going all day. He never turns

it off.

— Turn on someone: attack. As I left the building, the guard

dog turned on me and bit my leg.

— Turn someone on: give great pleasure, excite sexually.

Certain illicit drugs turn you on very quickly.

— Turn something on: allow gas, electricity, water to flow.

Make sure the computer is turned on first thing.

— Turn someone out: force someone to leave a place. I’ve

nowhere to sleep. My partner has turned me out.

— Turn something out: extinguish light or fire. Please turn out

the lights before going home.

— Turn out: prove to be. I never thought it would turn out to be

fatal.

— Turn over: change position of body by rolling. Turn over onto

your left side and draw your knees to your chest.

— Turn someone/something round: face in different direc-

tion. Turn round and let me look at your back.

— Turn to someone/something: go for advice, help. (a) The

practice nurse is a good person to turn to when you need
health advice. (b) Sadly, when his wife left him he turned to
drink for solace.

— Turn up:

i. appear, arrive. Mr Fox hasn’t turned up yet for his

appointment.

ii. be found, by chance, after being lost. Thank goodness

those keys have turned up. We thought they’d been
stolen.

— Turn something up: increase volume of radio, TV, etc. I have

to turn up my hearing aid to listen to the news.

PHRASAL VERBS

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Abbreviations used in
nursing

INTRODUCTION

The rapid developments in nursing, healthcare and the related
sciences in recent years have brought a vast increase in the asso-
ciated vocabulary. At the same time, the increased speed of life
has driven people to use abbreviations more and more, and this
tendency is well illustrated in the nursing and healthcare field.

The use of abbreviations is discouraged because they are vari-

able and misleading. The same initials may have different mean-
ings in different areas of nursing practice. For example, PID may
mean pelvic inflammatory disease or prolapsed intervertebral disc.
The Nursing and Midwifery Council is clear about the need to
avoid the use of abbreviations in record keeping and documen-
tation (NMC 2002) (see Ch. 4).

Nevertheless, you will see and hear abbreviations being used

every day in medical reports and notes and in discussions about
patients and during handover reports, and a knowledge of them
is, therefore, absolutely essential. You should always ask if you
are not sure what an abbreviation means.

A selection of abbreviations commonly used by nurses and

other health professionals is provided to help you understand
what people mean.

193

AA – Alcoholics Anonymous
AAA – abdominal aortic

aneurysm

ABG – arterial blood gas
a.c. – ante cibum (Latin –

sometimes used in pre-
scriptions), before food

ACE – angiotensin-converting

enzyme

ACTH – adrenocorticotrophic

hormone

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194

ADH – antidiuretic hormone
ADHD – attention-deficit

hyperactivity disorder

ad lib – ad libitum (Latin), to

the desired amount

ADLs – Activities of Daily

Living

ADRs – adverse drug

reactions

A&E – Accident and

Emergency Department

AF – atrial fibrillation
AFB – acid-fast bacilli
AFP – a-fetoprotein
AI – artificial insemination
AIDS – acquired immune

deficiency syndrome

ALL – acute lymphoblastic

leukaemia

ALs – Activities of Living
ALS – advanced life support
ALT – alanine

aminotransferase

AMI – acute myocardial

infarction

AML – acute myeloid

leukaemia

ANC – antenatal care
ANS – autonomic nervous

system

AP – anteroposterior
APEL – accreditation of

prior experience and
learning.

APH – antepartum haemor-

rhage

APKD – adult polycystic

kidney disease

ARC – AIDS-related complex
ARDS – adult respiratory

distress syndrome

ARF – (1) acute renal failure;

(2) acute respiratory
failure

ASD – atrial septal defect
AST – aspartate

aminotransferase

ATN – acute tubular necrosis
ATD – Alzheimer’s-type

dementia

A-V – atrioventricular: (1)

node; (2) bundle

BAI – Beck Anxiety

Inventory

BAN – British Approved

Name (of drugs)

BBA – born before arrival
BBB – (1) blood–brain barrier;

(2) bundle branch block

BBVs – blood-borne viruses
BCG – bacille Calmette

Guérin

b.d. – bis die (Latin – some-

times used in prescrip-
tions), twice daily

BDI – Beck Depression

Inventory

BHS – Beck Hopelessness

Scale

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ABBREVIATIONS USED IN NURSING

195

b.i.d. – bis in die (Latin),

twice a day

BID – brought in dead
BLS – basic life support
BMI – body mass index
BMR – basal metabolic rate
BMT – bone marrow

transplant

BN – Bachelor of Nursing
BNF – British National

Formulary

BNO – bowels not opened
BO – bowels opened
BP – (1) blood pressure; (2)

British Pharmacopoeia

BPH – benign prostatic

hyperplasia

BPRS – Brief Psychiatric

Rating Scale

BSA – body surface area
BSc – Bachelor of Science
BSc (Soc Sc-Nurs) –

Bachelor of Science
(Nursing)

BSE – (1) bovine spongiform

encephalopathy; (2) breast
self-examination

BSS – Beck Scale for Suicide

Ideation

B Wt – birth weight

C – (1) carbon; (2) centigrade

(temperature scale)

Ca – carcinoma

CABG – coronary artery

bypass grafting

CAN – Camberwell

Assessment of Need

CAPD – continuous ambula-

tory peritoneal dialysis

CAPE – Clifton Assessment

Procedures for the Elderly

CATS – credit accumulation

transfer scheme

cc – cubic centimetre
CCF – congestive cardiac

failure

CCU – Coronary Care Unit
CD – controlled drug
CDC – Centers for Disease

Control and Prevention

CDS – Calgary Depression

Scale

CEA – carcinoembryonic

antigen

CF – (1) cardiac failure;

(2) cystic fibrosis

CHAI – Commission for

Healthcare Audit and
Inspection

CHD – (1) congenital heart

disease; (2) coronary heart
disease

CHF – congestive heart

failure

CIN – cervical intraepithelial

neoplasia

CINAHL – Cumulative Index

to Nursing and Allied
Health Literature

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196

CJD – Creutzfeldt–Jakob

disease

CK – creatine kinase
CLL – chronic lymphatic

leukaemia

cm – centimetre
CML – chronic myeloid

leukaemia

CMV – cytomegalovirus
CNS – (1) central nervous

system; (2) clinical nurse
specialist

C/O – complains of
COPD – chronic obstructive

pulmonary disease

COSHH – Control of

Substances Hazardous
to Health

CPA – care programme

approach

CPAP – continuous positive

airways pressure

CPD – continuing professional

development

CPN – community psychiatric

nurse

CPR – cardiopulmonary

resuscitation

CRF – chronic renal failure
CSCI – Commission for

Social Care Inspection

CSF – (1) cerebrospinal fluid;

(2) colony stimulating
factor

CSI – Caregiver Strain

Index

CSSD – Central Sterile Supply

Department

CSU – catheter specimen of

urine

CT – (1) computed tomogra-

phy; (2) coronary
thrombosis

CTG – cardiotocograph
CV – (1) cardiovascular;

(2) curriculum vitae

CVA – cerebrovascular

accident

CVP – central venous

pressure

CVS – (1) cardiovascular

system; (2) chorionic
villus sampling

CVVH – continuous venous–

venous haemofiltration

CVVHD – continuous

venous–venous
haemodialfiltration

Cx – cervix
CXR – chest X-ray

DADL – Domestic Activities

of Daily Living

D&C – dilatation and

curettage

DC – direct current
DDH – developmental

dysplasia of the hip

DIC – disseminated intravas-

cular coagulation

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ABBREVIATIONS USED IN NURSING

197

DipEd – Diploma in

Education

DipHE – Diploma in Higher

Education

DipN – Diploma in Nursing
DipNEd – Diploma in

Nursing Education

DKA – diabetic ketoacidosis
DM – diabetes mellitus
DN – district nurse
DNA – (1) deoxyribonucleic

acid; (2) did not attend

DOA – dead on arrival
DOB – date of birth
DoH – Department of Health
DPhil – Doctor of Philosophy
DRS – Delusions Rating Scale
DRV – dietary reference value
DSH – deliberate self-harm
DT – delirium tremens
DTPer – diphtheria, tetanus

and pertussis vaccine

DU – duodenal ulcer
DVT – deep venous

thrombosis

D&V – diarrhoea and

vomiting

DXR – deep X-ray radiation
DXT – deep X-ray therapy

EAR – estimated average

requirement

EBM – expressed breast milk
EBP – evidence-based practice

EBS – emergency bed service
EBV – Epstein–Barr virus
ECF – extracellular fluid
ECG – electrocardiogram
ECI – Experience of

Caregiving Inventory

ECMO – extracorporeal

membrane oxygenator

ECT – electroconvulsive

therapy

EDC – expected date of

confinement

EDD – expected date of

delivery

EEG – electroencephalogram
EFAs – essential fatty acids
ELISA – enzyme-linked

immunosorbent assay

EMD – electromechanical

dissociation

EMG – electromyography
EMLA – eutectic mixture of

local anaesthetics

EMU – early morning speci-

men of urine

ENT – ears, nose and throat
EOG – electro-oculogram
ERCP – endoscopic retro-

grade cholangiopancreato-
graphy

ERG – electroretinogram
ERPC – evacuation of

retained products of
conception

ERV – expiratory reserve

volume

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198

ESR – erythrocyte sedimenta-

tion rate

ESRD – end-stage renal

disease

ESS – Early Signs Scale
ESWL – extracorporeal shock

wave lithotripsy

ET – (1) embryo transfer; (2)

endotracheal

EUA – examination under

anaesthesia

F – (1) Fahrenheit (tempera-

ture scale); (2) female

FAS – fetal alcohol syndrome
FB – foreign body
FBC – full blood count
FBS – fasting blood sugar
FETC – Further Education

Teaching Certificate

FEV – forced expiratory

volume

FFP – fresh frozen plasma
FH – (1) family history; (2)

fetal heart

FHH – fetal heart heard
FHNH – fetal heart not

heard

FMF – fetal movement felt
FPC – Family Planning Clinic
FPCert – Family Planning

Certificate

FRC – functional residual

capacity

FRCN – Fellow of the Royal

College of Nursing

FSH – follicle stimulating

hormone

FTND – full-term normal

delivery

FVC – forced vital capacity

g – gram
GA – general anaesthetic
GC – gonococcus
GCS – Glasgow Coma Scale
GFR – glomerular filtration

rate

GGT – g-glutamyl transferase
GH – growth hormone
GHQ – General Health

Questionnaire

GI – gastrointestinal
GIFT – gamete intrafallopian

transfer

GIT – gastrointestinal tract
GOR – gastro-oesophageal

reflux

GP – general practitioner
GSL – General Sales List

(medicines)

GTN – glyceryl trinitrate
GTT – glucose tolerance test
GU – (1) gastric ulcer;

(2) genitourinary

GUM – genitourinary

medicine

GUS – genitourinary system

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ABBREVIATIONS USED IN NURSING

199

GVHD – graft versus host

disease

Gyn – gynaecology

HAI – hospital-acquired

infection

HAV – hepatitis A virus
HAVS – hand–arm vibration

syndrome

Hb – haemoglobin
HBIG – hepatitis B

immunoglobulin

HBV – hepatitis B virus
HC – head circumference
HCA – healthcare assistant
HCG (hCG) – human chori-

onic gonadotrophin

HCV – hepatitis C virus
HDL – high-density

lipoprotein

HDSU – Hospital Disinfection

and Sterilisation Unit

HDU – High Dependency Unit
HDV – hepatitis D virus
HEV – hepatitis E virus
HFEA – Human Fertilisation

and Embryology Authority

HHNK – hyperglycaemic

hyperosmolar non-ketotic

HI – head injury
Hib vaccine – Haemophilus

influenzae type B vaccine

HImP – Health Improvement

Programme

HIV – human immunodefi-

ciency virus

HNPU – has not passed

urine

HoNOS – Health of the

Nation Outcome Scale

HPA – Health Protection

Agency

HPV – human papilloma virus
HR – heart rate
HRS – Hallucinations Rating

Scale

HRT – hormone-replacement

therapy

HSV – herpes simplex virus
Ht – height
HUS – haemolytic uraemic

syndrome

HV – Health Visitor
HVCert – Health Visitor’s

Certificate

HVT – Health Visitor Teacher

IABP – intra-aortic balloon

pump

IADL – Instrumental Activities

of Daily Living

IBD – inflammatory bowel

disease

IBS – irritable bowel

syndrome

IC – inspiratory capacity
ICD – International

Classification of Disease

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200

ICE – ice, compress and

elevate

ICF – intracellular fluid
ICN – (1) Infection Control

Nurse; (2) International
Council of Nurses

ICP – intracranial pressure
ICSH – interstitial cell stimu-

lating hormone

ICU – Intensive Care Unit
ID – infectious disease
IDDM – insulin-dependent

diabetes mellitus

IE – infective endocarditis
IGT – impaired glucose

tolerance

IHD – ischaemic heart

disease

IM – (1) infectious mononu-

cleosis; (2) intramuscular

IMV – intermittent mandatory

ventilation

INR – (1) Index of Nursing

Research; (2) international
normalised ratio

IOL – intraocular lens
IOP – intraocular pressure
IPD – intermittent peritoneal

dialysis

IPP – intermittent positive

pressure

IPPV – intermittent positive

pressure ventilation

IQ – intelligence quotient
IRV – inspiratory reserve

volume

IS – Insight Scale
IT – information technology
ITU – Intensive Therapy Unit
IU – international unit
IUD – intrauterine (contracep-

tive) device

IUI – intrauterine

insemination

IV – intravenous
IVC – inferior vena cava
IVF – in vitro fertilisation
IVI – intravenous infusion
IVU – intravenous urogram

JCA – juvenile chronic

arthritis

JVP – jugular venous pressure

KASI – Knowledge about

Schizophrenia Interview

KS – Kaposi’s sarcoma
KUB – kidney, ureter and

bladder

L, l – litre
LA – (1) left atrium; (2) local

anaesthetic; (3) local
authority

lb – pound (of weight)
LBP – low back pain

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ABBREVIATIONS USED IN NURSING

201

LDH – lactate dehydrogenase
LDL – low-density lipoprotein
LDQ – Leeds Dependence

Questionnaire

LFTs – liver function tests
LH – luteinising hormone
LIF – left iliac fossa
LMN – lower motor neuron
LMP – last menstrual period
LOC – level of consciousness
LP – lumbar puncture
LRNI – lower reference nutri-

ent intake

LRTI – lower respiratory tract

infection

LSCS – lower segment

Caesarean section

LTM – long-term memory
LUNSERS – Liverpool

University Neuroleptic
Side Effect Rating Scale

LV – left ventricle
LVAD – left ventricular assist

device

LVF – left ventricular failure
LVH – left ventricular

hypertrophy

M – male
MA – Master of Arts
MAC – mid-arm

circumference

mane – in the morning (of

drugs); tomorrow

MAO – monoamine oxidase

inhibitor

MBC – maximal breathing

capacity

MCA – Medicines Control

Agency (now merged with
Medical Devices Agency)

MCH – mean cell

haemoglobin

MCHC – mean cell haemo-

globin concentration

MCL – mid-clavicular line
MCV – mean cell volume
MDA – Medical Devices

Agency (now merged
with Medicines Control
Agency)

MDR-TB – multidrug resistant

tuberculosis

ME – myalgic

encephalomyelitis

MEd – Master of Education
M/F; M/W/S/D – male/

female; married/widowed/
single/divorced

MHRA – Medicines and

Healthcare products
Regulatory Agency
(formed from the MCA
and MDA)

MI – (1) mitral incompetence

or insufficiency; (2)
myocardial infarction

mmHg – millimetres of

mercury

mmol – millimole

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202

MMR – measles mumps and

rubella (as in vaccine)

MMV – mandatory minute

volume

MODS – multiple organ

dysfunction syndrome

MODY – maturity onset

diabetes of the young

MPhil – Master of Philosophy
MRI – magnetic resonance

imaging

MRSA – methicillin-resistant

Staphylococcus aureus

MS – (1) mitral stenosis;

(2) multiple sclerosis;
(3) musculoskeletal

MSc – Master of Science
MSH – melanocyte-

stimulating hormone

MSP – Munchausen syndrome

by proxy

MSU – mid-stream urine
MSW – medical social worker
MT – midwifery teacher
MTD – Midwife Teachers’

Diploma

MWO – mental welfare

officer

NAD – no abnormality

detected

NAI – non-accidental injury
NAS – no added salt
NBI – no bone injury

NBM – nil (nothing) by

mouth

NCVQ – National Council for

Vocational Qualifications

ND – normal delivery
NFA – (1) no fixed abode;

(2) no further action

NG – nasogastric
NHL – non-Hodgkin’s

lymphoma

NHS – National Health

Service

NICE – National Institute for

Clinical Excellence

NICU – Neonatal Intensive

Care Unit

NIDDM – non-insulin-

dependent diabetes
mellitus

NIPPV – non-invasive positive

pressure ventilation

NMC – Nursing and

Midwifery Council

NMR – nuclear magnetic

resonance

nocte – in the evening (of

drugs)

NPF – Nurse Prescribers’

Formulary

NPU – not passed urine
NRDS – neonatal respiratory

distress syndrome

NREM – non-rapid eye

movement (sleep)

NSAIDs – non-steroidal anti-

inflammatory drugs

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ABBREVIATIONS USED IN NURSING

203

NSFs – National Service

Frameworks

NSP – non-starch

polysaccharides

NSU – non-specific urethritis
NT – nurse teacher
N&V – nausea and vomiting
NVQ – National Vocational

Qualification

OA – osteoarthritis
OBS – organic brain syndrome
OCD – obsessive–compulsive

disorder

o.d. – omni die (Latin –

sometimes used in
prescriptions), daily

OD – overdose
ODP – operating department

practitioner

O/E, OE – on examination
OGD – oesophagogastroduo-

denoscopy

OHNC – Occupational Health

Nursing Certificate

o.m. – omni mane

(Latin – sometimes used
in prescriptions), in the
morning

o.n. – omni nocte (Latin –

sometimes used in
prescriptions), at night

ONC – Orthopaedic Nurses’

Certificate

OND – Ophthalmic Nursing

Diploma

OPCS – Office of Population

Censuses and Surveys

OPD – Outpatients

Department

ORT – oral rehydration

therapy

OT – occupational therapist

(therapy)

OTC – over the counter

(drugs bought without a
prescription)

OU – Open University

P – pulse
PAC – premature atrial

contraction

PADL – Personal Activities of

Daily Living

PAFC – pulmonary artery

flotation catheter

PALS – paediatric advanced

life support

PANSS – Positive and

Negative Syndrome Scale

Pap – Papanicolaou smear

test

PAT – paroxysmal atrial

tachycardia

PAWP – pulmonary artery

wedge pressure

PBD – peak bone density
PBM – peak bone mass

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204

p.c. – post cibum (Latin –

sometimes used in
prescriptions), after
food

PCAG – primary closed-angle

glaucoma

PCA(S) – patient-controlled

analgesia (system)

PCEA – patient-controlled

epidural analgesia

PCM – protein–calorie

malnutrition

PCP – Pneumocystis carinii

pneumonia

PCT – Primary Care Trust
PCV – packed cell volume
PCWP – pulmonary capillary

wedge pressure

PD – peritoneal dialysis
PDA – patent ductus

arteriosus

PDP – personal development

plan

PE – pulmonary embolus
PEEP – positive end-

expiratory pressure

PEFR – peak expiratory flow

rate

PEG – percutaneous endo-

scopic gastrostomy

PEM – protein–energy

malnutrition

PET – (1) positron emission

tomography; (2) pre-
eclamptic toxaemia

PFI – private finance initiative

PFR – peak flow rate
PGL – persistent generalised

lymphadenopathy

pH – hydrogen ion

concentration

PHCT – Primary Health Care

Team

PhD – Doctor of Philosophy
PHLS – Public Health

Laboratory Service

PICC – peripherally inserted

central catheter

PICU – Paediatric Intensive

Care Unit

PID – (1) pelvic inflammatory

disease; (2) prolapsed
intervertebral disc

PKU – phenylketonuria
PL – perception of light
PM – postmortem
PMB – postmenopausal

bleeding

PMH – past medical history
PMS – premenstrual

syndrome

PMT – premenstrual tension
PN – postnatal
PND – paroxysmal nocturnal

dyspnoea

POAG – primary open-angle

glaucoma

POM – prescription only

medicine

PONV – postoperative nausea

and vomiting

POP – plaster of Paris

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ABBREVIATIONS USED IN NURSING

205

PPD – (1) progressive

perceptive deafness; (2)
purified protein derivative

PPH – post-partum

haemorrhage

PPS – plasma protein solution
PPV – positive pressure

ventilation

PR – per rectum
PREP – post-registration

education and practice

PRL – prolactin
p.r.n. – pro re nata (Latin –

sometimes used in pre-
scriptions), when required

PSA – prostate-specific

antigen

PSCT – Pain and Symptom

Control Team

PSV – pressure support

ventilation

PT – (1) physiotherapist;

(2) prothrombin

PTA – prior to admission
PTC – percutaneous transhep-

atic cholangiography

PTCA – percutaneous translu-

minal coronary angioplasty

PTH – parathyroid hormone
PTSD – post-traumatic stress

disorder

PTT – partial thromboplastin

time

PU – passed urine
PUFA – polyunsaturated fatty

acid

PUO – pyrexia of unknown

origin

PV – per vagina
PVD – peripheral vascular

disease

PVS – persistent vegetative

state

PVT – paroxysmal ventricular

tachycardia

QALY – quality-adjusted life-

year

q.d.s. – quater die sumendus

(Latin – sometimes used
in prescriptions), four
times a day

q.i.d. – quater in die (Latin),

four times a day

QIDN – Queen’s Institute of

District Nursing

q.q.h. – quarta quaque hora

(Latin), every 4 hours

R – respiration
RA – (1) rheumatoid arthritis;

(2) right atrium

RAI – Relatives’ Assessment

Interview

RAISSE – Relatives’

Assessment Interview for
Schizophrenia in a Secure
Environment

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RBC – (1) red blood cell; (2)

red blood cell count

RBS – random blood sugar
RCC – red cell concentrate
RCM – Royal College of

Midwives

RCN – Royal College of Nurs-

ing and National Council
of Nurses of the UK

RCNT – Registered Clinical

Nurse Teacher

RCT – randomised controlled

trial

RDA – recommended daily

allowance

REM – rapid eye movement

(sleep)

RG – remedial gymnast
RGN – Registered General

Nurse

Rh – rhesus factor
RHD – rheumatic heart

disease

RHV – Registered Health

Visitor

RICE – rest, ice, compress,

elevation

RIF – right iliac fossa
rINN – recommended inter-

national non-proprietary
name

RIP – raised intracranial

pressure

RM – Registered Midwife
RMN – Registered Mental

Nurse

RN – Registered Nurse
RNA – ribonucleic acid
RNI – reference nutrient

intake

RNIB – Royal National

Institute for the Blind

RNID – Royal National

Institute for the Deaf

RNMH – Registered Nurse for

the Mentally Handicapped

RNT – Registered Nurse Tutor
RO – reality orientation
ROM – range of movement

(exercises)

ROS – removal of sutures
RS – respiratory system
RSCN – Registered Sick

Children’s Nurse

RSI – repetitive strain injury
RSV – respiratory syncytial

virus

RTA – (1) renal tubular acido-

sis; (2) road traffic
accident

RTI – respiratory tract

infection

RV – (1) residual volume;

(2) right ventricle

RVF – right ventricular failure

SAD – seasonal affective

disorder

SAH – subarachnoidal

haemorrhage

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ABBREVIATIONS USED IN NURSING

207

SAI – sexually acquired

infection

SANS – Schedule for

Assessment of Negative
Symptoms

SARS – severe acute respira-

tory syndrome

SC – subcutaneous
SCBU – Special Care Baby Unit
SCC – (1) spinal cord com-

pression; (2) squamous
cell carcinoma

SCD – sequential pneumatic

compression device

SCM – State Certified Midwife
SDAT – senile dementia

Alzheimer type

SDH – subdural haematoma
SERMs – selective (o)estro-

gen receptor modulators

SFS – Social Functioning Scale
SG – specific gravity
SGA – small for gestational

age

SHHD – Scottish Home and

Health Department

SHO – senior house officer
SI Units – Système

International d’Unités

SIB – self-injurious behaviour
SIDS – sudden infant death

syndrome

SIMV – synchronised intermit-

tent mandatory ventilation

SLE – systemic lupus

erythematosus

SLS – social and life skills
SLT – speech and language

therapist (therapy)

SMR – (1) standardised mor-

tality rate; (2) submucous
resection

SNAP – Schizophrenia

Nursing Assessment
Protocol

SOB – short of breath
SPECT – single photon

emission computed
tomography

SPF – sun protection factor
SRN – State Registered Nurse
SSRIs – selective serotonin

re-uptake inhibitors

stat. – statim (Latin – some-

times used in prescrip-
tions), immediately

STD – sexually transmitted

disease

STI – sexually transmitted

infection

STM – short-term memory
STs – sanitary towels
SVC – superior vena cava
SVQs – Scottish Vocational

Qualifications

SVT – supraventricular

tachycardia

SWD – short-wave diathermy

T – temperature

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208

T&A – tonsils and adenoids
TB – tuberculosis
TCA – tricyclic antidepressants
TCI – to come in
t.d.s. – ter die sumendus

(Latin – sometimes used in
prescriptions), three times
a day

TEDs – thromboembolic

deterrent (stockings)

TEN – toxic epidermal

necrolysis

TENS – transcutaneous elec-

trical nerve stimulation

TIA – transient ischaemic

attack

t.i.d. – ter in die (Latin), three

times a day

TIPSS – transjugular intrahep-

atic portasystemic stent
shunting

TLC – total lung capacity
TLS – tumour lysis syndrome
TNF – tumour necrosis factor
TNM – tumour, node,

metastasis

TOP – termination of

pregnancy

TPN – total parenteral

nutrition

TPR – temperature, pulse,

respiration

TRIC – trachoma inclusion

conjunctivitis

TSF – triceps skin-fold

thickness

TSH – thyroid-stimulating

hormone

TSS – toxic shock syndrome
TT – (1) tetanus toxoid;

(2) thrombin clotting time;
(3) tuberculin tested

TTA(O) – to take away (out)
TUR – transurethral resection
TURP – transurethral

resection of the prostate
gland

TURT – transurethral

resection of tumour

TV – (1) tidal volume; (2)

Trichomonas vaginalis

U – unit
U&E – urea and electrolytes
UG – urogenital
UGS – urogenital system
UGT – urogenital tract
UKCC – UK Central Council

for Nursing, Midwifery and
Health Visiting (replaced
by Nursing and Midwifery
Council)

UMN – upper motor neuron
URTI – upper respiratory tract

infection

USS – ultrasound scan
UTI – urinary tract infection
UVA – ultraviolet A
UVB – ultraviolet B
UVL – ultraviolet light

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ABBREVIATIONS USED IN NURSING

209

VA – visual acuity
VAS – visual analogue

scale

VBI – vertebrobasilar

insufficiency

VC – vital capacity
VD – venereal disease (out-

dated term)

VE – vaginal examination
VF – ventricular fibrillation
VFM – value for money
VLDL – very-low-density

lipoprotein

VRE – vancomycin-resistant

enterococci

VRS – Verbal Rating Scale
VSD – ventricular septal

defect

VT – ventricular tachycardia
VUR – vesicoureteric reflux

VV – varicose vein(s)
VZIG – varicella-zoster

immunoglobulin

VZV – varicella-zoster virus

WBC – (1) white blood cell;

(2) white blood cell count

WC – water closet (lavatory)
WHO – World Health

Organisation

WPW – Wolff–Parkinson–

White syndrome

Wt – weight

ZIFT – zygote intrafallopian

transfer

ZN – Ziehl–Neelsen (stain)

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Useful addresses and
web sources

Some useful addresses and web sources are provided in this
chapter. They will help you to get up-to-date information about
the sort of issues that are important for a satisfying and success-
ful nursing career in the UK. These include: immigration, registra-
tion as a nurse in the UK, welfare and employment, and educa-
tion opportunities. Also included are some sources of information
for your patients and their families.

INFORMATION FOR NURSES

Addresses and websites

Commission for Racial Equality
Elliot House
10–12 Allington Street
London SW1E 5EH
http://www.cre.gov.uk

Commonwealth Nurses Federation
c/o International Department
Royal College of Nursing
20 Cavendish Square
London W1M 0AB

Community and District Nursing Association (CDNA)
Westel House
32–38 Uxbridge Road
Ealing
London W5 2BS
http://www.cdna.tvu.ac.uk

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Community Practitioners’ and Health Visitors’ Association

(CPHVA)

40 Bermondsey Street
London SE1 3UD
http://www.amicus-cphva.org
(Affiliated to Amicus)

Department of Health
Richmond House
79 Whitehall
London SW1A 2NS
http://www.dh.gov.uk

Equal Opportunities Commission
Arndale House
Arndale Centre
Manchester M4 5EQ
http://www.eoc.org.uk

GMB
22/24 Worple Road
London SW19 4DD
http://www.gmb.org.uk

Health & Safety Executive
Rose Court
2 Southwark Bridge
London SE1 9HS
http://www.hse.gov.uk

Health Service Commissioner
13th Floor Millbank
Millbank Tower
London SW1P 4QP
http://www.health.ombudsman.org.uk

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HM Customs and Excise
Dorset House
Stamford Street
London SE1 9PY
http://www.hmce.gov.uk
(Advice on bringing personal effects and goods into the UK)

Home Office
Immigration and Nationality Enquiry Bureau
Block C
Whitgift Centre
Wellesley Road
Croydon CR9 1AT
http://www.homeoffice.gov.uk
(Immigration and Nationality – information on entry visas
and work permits)

Immigration Advisory Service (IAS)
County House
190 Great Dover Street
London SE1 4YB
http://www.iasuk.org
(Independent charity that gives free confidential advice and
help with applying for entry clearance to the UK)

International Confederation of Midwives
10 Barley Mow Passage
London W4 4PH

International Council of Nurses (ICN)
3 Place Jean Marteau
1201 Geneva
Switzerland
http://www.icn.ch

USEFUL ADDRESSES AND WEB SOURCES

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Mental Health Nurses’ Association (formerly CPNA)
Cals Meyn
Grove Lane
Hinton
Nr Chippenham
Wilts SN14 8HF
(Affiliated to Amicus)

Nurses Welfare Service
Victoria Chambers
16/18 Strutton Ground
London SW1P 2HP

Nursing and Midwifery Council (NMC)
Overseas Registration
23 Portland Place
London W1N 3PZ
http://www.nmc-uk.org
(Provides information about registering as a nurse or midwife
in the UK)

Royal College of Midwives
15 Mansfield Street
London W1G 9NH
http://www.rcm.org.uk

Royal College of Nursing of the United Kingdom
20 Cavendish Square
London W1M 0AB
http://www.rcn.org.uk/whyjoin/howtojoin
(Provides general information on how to become registered as
a nurse in the UK)

Royal Commonwealth Society
18 Northumberland Avenue
London WC2N 5BJ

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Scottish Health Department
St. Andrew’s House
Regent Road
Edinburgh EH1 3DE
http://www.scotland.gov.uk

Unison (Head Office)
1 Mabledon Place
London WC1H 9HA
http://www.unison.org.uk

World Health Organisation
Avenue Appia
1211 Geneva 27
Switzerland
http://www.who.org

Web resources

Citizens Advice Bureaux (CAB) – give free advice on many

issues. Branches can be found in most large towns and cities:
http://www.adviceguide.org.uk

Foreign and Commonwealth Office – gives details about visa

requirements for visitors wishing to enter the UK:
http://www.fco.gov.uk

International English Language Testing System – useful informa-

tion about the IELTS test and the centres which run the test,
etc.: http://www.ielts.org

Nursing courses – full guide to nursing courses in the UK:

http://www.nursingcourses.co.uk

Nursing in the UK – information about immigration procedures:

http://www.nursingintheuk.co.uk

NursingNetUK – information about nursing in the UK, job vacan-

cies and courses: http://www.nursingnetuk.com

Nursing Times – information about the weekly journal, nursing

issues, and job vacancies on NT Job Alert:
http://www.nursingtimes.net

USEFUL ADDRESSES AND WEB SOURCES

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Office of the Immigration Services Commissioner – UK govern-

ment regulator for immigration services. Information and
complaints: http://www.oisc.gov.uk

University of Sheffield School of Nursing and Midwifery –

supports international students in a wide variety of academic
programmes:
http://www.snm.shef.ac.uk/snm/internat/internat.htm

INFORMATION FOR PATIENTS AND FAMILIES

Addresses and websites

Action for Sick Children
300 Kingston Road
London SW20 8LX
http://www.actionforsickchildren.org

Age Concern (England)
1268 London Road
London SW16 4ER
http://www.ace.org.uk

Alcoholics Anonymous
PO Box 1
Stonebow House
Stonebow
York YO1 2NJ
http://www.alcoholics-anonymous.org.uk

Alzheimer’s Society
Gordon House
10 Greencoat Place
London SW1P 1PH
http://www.alzheimers.org.uk

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Arthritis Care
18 Stephenson Way
London NW1 2HD
http://www.arthritiscare.org.uk

Association of Carers
20–25 Glasshouse Yard
London EC1A 4JS

Breast Cancer Care
Kiln House
210 New King’s Road
London SW6 4NZ
http://www.breastcancercare.org.uk

British Association for Cancer United Patients BACUP
3 Bath Place
Rivington Street
London EC2 3JR
http://www.cancerbacup.org.uk

British Colostomy Association
15 Station Road
Reading RG1 1LG
http://www.bcass.org.uk

British Deaf Association
1–3 Worship Street
London EC2A 2AB
http://www.bda.org.uk

British Epilepsy Association
New Anstey House
Gate Way Drive
Leeds LS3 1BE
http://www.epilepsy.org.uk

USEFUL ADDRESSES AND WEB SOURCES

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British Heart Foundation
14 Fitzhardinge Street
London W1H 4DH
http://www.bhf.org.uk

British Pregnancy Advisory Service
Austy Manor
Wootton Wawen
Solihull
West Midlands B95 6BX
http://www.bpas.org.uk

British Red Cross
9 Grosvenor Crescent
London SW1X 7EJ
http://www.redcross.org.uk

Capability (formerly Spastics Society)
12 Park Crescent
London W1N 4EQ

Diabetes UK
10 Queen Anne Street
London W1M 0BD
http://www.diabetes.org.uk

Disabled Living Foundation
380–384 Harrow Road
London W9 2HU
http://www.dlf.org.uk

Ileostomy & Internal Pouch Support Group
Amblehurst House
PO Box 23
Mansfield NG18 4TT

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Leukaemia Society
14 Kingfisher Court
Venny Bridge
Pinhoe
Exeter EX4 8JN

Macmillan Cancer Relief
89 Albert Embankment
London SE1 7UQ
http://www.macmillan.org.uk

MIND – National Association for Mental Health
Granta House
15–19 Broadway
London E15 4BQ
http://www.mind.org.uk

Multiple Sclerosis Society
National Centre
372 Edgware Road
London NW2 6ND
http://www.mssociety.org.uk

National Aids Trust
New City Cloisters
196 Old Street
London EC1V 9FR
http://www.nat.org.uk

National Asthma Campaign
Providence House
Providence Place
London N1 0NT
http://www.asthma.org.uk

USEFUL ADDRESSES AND WEB SOURCES

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National Society for the Prevention of Cruelty to Children

(NSPCC)

42 Curtain Road
London EC2A 3NH
http://www.nspcc.org.uk

Royal National Institute of the Blind (RNIB)
105 Judd Street
London WC1H 9NE
http://www.rnib.org.uk

Royal National Institute for the Deaf (RNID)
19–23 Featherstone Street
London EC1Y 8SL
http://www.rnid.org.uk

St. Andrews Ambulance Association
St. Andrew’s House
48 Milton Street
Glasgow G4 0HR
http://www.firstaid.org.uk

St. John Ambulance Association & Brigade
1 Grosvenor Crescent
London SW1X 7EF
http://www.sja.org.uk

Sickle Cell Society
54 Station Road
Harlesden
London NW10 4UA
http://www.sicklecellsociety.org

Stillbirth & Neonatal Death Society (SANDS)
28 Portland Place
London W1N 4DE

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Stroke Association
123–127 Whitecross Street
London EC1Y 8JJ
http://www.stroke.org.uk

Terrence Higgins Trust
52–54 Grays Inn Road
London WC1X 8JU
http://www.tht.org.uk

USEFUL ADDRESSES AND WEB SOURCES

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Units of measurement

UNITS OF MEASUREMENT: INTERNATIONAL SYSTEM
OF UNITS (SI),THE METRIC SYSTEM AND
CONVERSIONS

In the UK we use the International System of Units (SI) or
Système International d’Unités measurement system for scientific,
medical and technical purposes. The SI units have replaced those
of the Imperial System. For example, the kilogram is used for
weight (or mass) instead of the pound, and the metre for length
instead of yards, feet and inches. However, in everyday life you
will still see a mix of units used in shops and hear people talk
about pounds, and feet and inches. For example, they will ask for
a pound of apples and describe someone being 5 foot 3 inches in
height and 10 stone in weight.

The SI comprises seven base units, with several derived units.

Each unit has its own symbol and is expressed as a decimal mul-
tiple or submultiple of the base unit by using the appropriate pre-
fix (e.g. a millimetre is one-thousandth of a metre).

Base units

223

Quantity

Base unit and symbol

Length

metre (m)

Mass

kilogram (kg)

Time

second (s)

Amount of substance

mole (mol)

Electric current

ampere (A)

Thermodynamic temperature

kelvin (°K)

Luminous intensity

candela (cd)

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Derived units

Derived units for measuring different quantities are reached by
multiplying or dividing two or more of the seven base units.

Factor, decimal multiples and submultiples of SI units

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

224

Quantity

Derived unit and symbol

Work, energy, quantity of heat

joule (J)

Pressure

pascal (Pa)

Force

newton (N)

Frequency

hertz (Hz)

Power

watt (W)

Electrical potential, electromotive force,

volt (v)

potential difference

Absorbed dose of radiation

gray (Gy)

Radioactivity

becquerel (Bq)

Dose equivalent

sievert (Sv)

Multiplication factor

Prefix

Symbol

tera

giga

mega

kilo

hecto

deca

–1

deci

–2

centi

–3

milli

–6

micro

–9

nano

–12

pico

–15

femto

–18

atto

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Rules for using units and writing large numbers and
decimals

— The symbol for a unit is unaltered in the plural and should not

be followed by a full stop/point except at the end of a sen-
tence: i.e. 2 cm, not 2 cm. or 2 cms.

— Large numbers are written in three-digit groups (working from

right to left) with spaces not commas (in some countries the
comma is used to indicate a decimal point): e.g. forty thousand
is written as 40 000, four-hundred thousand is written as
400 000.

— Numbers with four numbers are written without the space: e.g.

six thousand is written as 6000.

— The decimal sign between numbers is indicated by a full

stop/point placed near the line: e.g. 40.75. If the numerical
value of the decimal is less than 1, a zero should appear before
the decimal sign: i.e. 0.125, not .125.

— Decimals with more than four numbers are also written in

three-digit groups, but this time working from left to right: e.g.
0.000 25.

— ‘Squared’ and ‘cubed’ are expressed as numerical powers and

not by abbreviation: e.g. square centimetre is cm

, not sq. cm.

Commonly used measurements requiring further
explanation

— Volume: volume is calculated by multiplying length, width and

depth. Using the SI unit for length, the metre (m), means end-
ing up with a cubic metre (m

), which is a huge volume and

it is not appropriate for most uses. In clinical practice the litre
(L or l) is used. A litre is based on the volume of a cube meas-
uring 10 cm × 10 cm × 10 cm. Smaller units still, e.g. millilitre
(mL) or one-thousandth of a litre, are commonly used in clin-
ical practice.

— Pressure: the SI unit of pressure is the pascal (Pa), and the

kilopascal (kPa) replaces the old non-SI unit of millimetres of

UNITS OF MEASUREMENT

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mercury pressure (mmHg) for blood pressure and blood gases.
However, mmHg are still widely used for measuring blood
pressure. Other anomalies include: cerebrospinal fluid, which
is measured in millimetres of water (mmH

O); and central

venous pressure, which is measured in centimetres of water
(cmH

O).

— Temperature: although the SI base unit for temperature is the

kelvin, by international convention temperature is measured in
degrees Celsius (°C).

— Energy: the energy of food or individual requirements for

energy are measured in kilojoules (kJ); the SI unit is the joule
(J). In practice, many people still use the kilocalorie (kcal), a
non-SI unit, for these uses. 1 calorie = 4.2 J; 1 kilocalorie (large
Calorie) = 4.2 kJ.

— Time: the SI base unit for time is the second (s), but it is

acceptable to use minute (min), hour (h) or day (d). In clini-
cal practice it is preferable to use ‘per 24 hours’ for the excre-
tion of substances in urine and faeces: i.e. g/24 h.

— Amount of substance: the SI base unit for amount of substance

is the mole (mol). The concentration of many substances is
expressed in moles per litre (mol/L) or millimoles per litre
(mmol/L), which replaces milliequivalents per litre (mEq/L).
Some exceptions exist and include: haemoglobin and plasma
proteins, which are given in grams per litre (g/L); and enzyme
activity, which is given in International Units (IU, U or iu).

MEASUREMENTS, EQUIVALENTS AND CONVERSIONS
(SI OR METRIC AND IMPERIAL)

Volume

1 litre (L) = 1000 millilitres (mL)

1 millilitre (mL) = 1000 microlitres (mL)

Note: The millilitre (mL) and the cubic centimetre (cm

) are usu-

ally treated as being equivalent.

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Conversions

1 litre (L) = 1.76 pints (pt)

568.25 millilitres (mL) = 1 pint (pt)

28.4 millilitres (mL) = 1 fluid ounce (fl oz)

Length

1 kilometre (km) = 1000 metres (m)

1 metre (m) = 100 centimetres (cm) or 1000 millimetres (mm)

1 centimetre (cm) = 10 millimetres (mm)

1 millimetre (mm) = 1000 micrometres (mm)

1 micrometre (mm) = 1000 nanometres (nm)

Conversions

1 metre (m) = 39.370 inches (in)

1 centimetre (cm) = 0.3937 inches (in)

30.48 centimetres (cm) = 1 foot (ft)

2.54 centimetres (cm) = 1 inch (in)

Weight or mass

1 kilogram (kg) = 1000 grams (g)

1 gram (g) = 1000 milligrams (mg)

1 milligram (mg) = 1000 micrograms (mg)

1 microgram (mg) = 1000 nanograms (ng)

Note: To avoid any confusion with milligram (mg) the word
microgram (mg) should be written in full on prescriptions.

UNITS OF MEASUREMENT

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Conversions

1 kilogram (kg) = 2.204 pounds (lb)

1 gram (g) = 0.0353 ounce (oz)

453.59 grams (g) = 1 pound (lb)

28.34 grams (g) = 1 ounce (oz)

Temperature conversions

To convert Celsius to Fahrenheit, multiply by 9, divide by 5, and
add 32 to the result. For example, to convert 36°C to Fahrenheit:

36 × 9 = 324 ∏ 5 = 64.8 + 32 = 96.8ºF

therefore 36ºC = 96.8ºF.

To convert Fahrenheit to Celsius, subtract 32, multiply by 5,

and divide by 9. For example, to convert 104ºF to Celsius:

104 – 32 = 72 × 5 = 360 ∏ 9 = 40ºC

therefore 104ºF = 40ºC.

Temperature comparison

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

228

°Celsius

°Fahrenheit

100

212

203

194

185

176

167

158

149

140

131

122

113

C3996_11.qxd 25/02/2004 18:46 Page 228

Note:

Boiling point = 100ºC = 212ºF
Freezing point = 0ºC = 32ºF

UNITS OF MEASUREMENT

229

°Celsius

°Fahrenheit

112.2

109.4

107.6

105.8

104

39.5

103.1

102.2

38.5

101.3

100.4

37.5

99.5

98.6

36.5

97.7

96.8

35.5

95.9

93.2

91.4

89.6

87.8

–5

–10

C3996_11.qxd 25/02/2004 18:46 Page 229

FURTHER READING

Gatford JD, Phillips N 2002 Nursing calculations, 6th edn.

Churchill Livingstone, Edinburgh.

PARKINSON AND BROOKER: EVERYDAY ENGLISH FOR INTERNATIONAL NURSES

230

C3996_11.qxd 25/02/2004 18:46 Page 230

General further reading
suggestions

Brooker C (ed) 2002 Churchill Livingstone’s dictionary of nurs-

ing, 18th edn. Churchill Livingstone, Edinburgh.

Brooker C, Nicol M (eds) 2003 Nursing adults: the practice of

caring. Mosby, Edinburgh.

Ellis RB, Gates B, Kenworthy N 2003 Interpersonal communica-

tion in nursing. Churchill Livingstone, Edinburgh.

Gunn C 2001 Using maths in health sciences. Churchill

Livingstone, Edinburgh.

Hoban V 2003 How to ... communicate better with your col-

leagues. Nursing Times 99:64–65.

Hutton A 2002 An introduction to medical terminology for

health care. A self-teaching package, 3rd edn. Churchill
Livingstone, Edinburgh.

MacConnachie AM, Hay J, Harris J, Nimmo S 2002 Drugs in

nursing practice. An A–Z guide, 6th edn. Churchill
Livingstone, Edinburgh.

Nicol M, Bavin C, Bedford-Turner S, et al 2004 Essential nursing

skills, 2nd edn. Mosby, Edinburgh.

Richards A, Edwards S 2003 A nurse’s survival guide to the

ward. Churchill Livingstone, Edinburgh.

Royal College of Nursing (RCN) 2003 Here to stay. International

nurses in the UK. Available:
www.rcn.org.uk/professional/publications/heretostay-irns.pdf

Wallace M 2002 Churchill Livingstone’s A–Z guide to profession-

al healthcare. Churchill Livingstone, Edinburgh.

231

C3996_12.qxd 25/02/2004 18:47 Page 231

C3996_12.qxd 25/02/2004 18:47 Page 232

This page intentionally left blank

Index

233

abbreviations 193–209
accident prevention 68–72
Accreditation of Prior Experience

and Learning (APEL) 17

Activities of Living Model of

Nursing 9, 51

Acute Care Trusts, NHS 17, 27, 30–4

medical staff 33
nursing staff 30–3
professions allied to medicine

and other staff 34

adaptation programmes (supervised

practice) 17–18, 20

allergies 56
Ambulance Service 30
ambulance trusts 30
anxiety 108

case histories 108–13
words associated with 108

arm, idioms for 141–2
assisted conception, colloquial

terms for 136

back, idioms for 142–4
biographical data 53–4
blood, idioms for 144–5
body function, colloquial terms for

126–9

body parts 142, 143, 144

colloquial terms for 123–6
idioms 141–67

bone, idioms for 145
brain, idioms for 145–6
break, phrasal verbs for 170
breast, idioms for 146

breathing 59–60

case history 60–4
words associated with 61

bring, phrasal verbs for 170–1
British Council 18
brow(s), idioms for 146

career development 21–2
cheek, idioms for 146
chest, idioms for 147
chin, idioms for 147
cleansing and dressing 89–92
clinical nurse specialist (CNS) 32
Code of Professional Conduct 3–4,

come, phrasal verbs for 171–3
communicating

case histories 65–8
words associated with 64

communication

anxiety, stress and depression

108–13

breathing 59–60
dementia and confusion 113–17
eating and drinking 78–84
elimination 84–9
mobility 72–8
pain 117–21
personal care 89–94
safety and accident prevention

68–72

sexuality 103–8
sleeping 94–8
starting 52–9
words associated with 64–8

C3996_13.qxd 26/02/2004 13:59 Page 233

INDEX

234

working and playing 98–103

communication in English, tests for

18–19

community mental health nurses 29
community midwives 29
Community NHS Trust 27
community nurses 5–6
community pharmacists 31
conception, assisted, colloquial

terms for 136

confusion 113

case histories 113–17
words associated with 114

contact with health/social care

professionals 58–9

continuing professional develop-

ment (CPD) 4, 19–20

curriculum vitae (CV) 21
cut, phrasal verbs for 173–4

dementia 113

case histories 113–17
words associated with 114

dental nurses 31
dentists 31
Department of Health (DoH) 26–7
depression 108

case histories 108–13
words associated with 108

dieticians 28, 59
district nurses (DNs) 28–9
do, phrasal verbs for 174–5
documentation 37–46

NMC guidelines for 45–6

dressing 89–92
drinking 78–84
drug chart 43
drugs 56–7

ears, idioms for 147–8
eating and drinking 78

case histories 78–84
words associated with 79

elbow, idioms for 148
electronic mail (e-mail) 49–50
elimination 84

case histories 84–9
words associated with 85

e-mail 49–50
employment history 54–5
endearments 52
English as a Second Language

(ESOL) 21

evidence-based care 1, 9
eye, idioms for 148–9

face, idioms for 149–50
family history 56
family planning, colloquial terms

for 136

feet, idioms for 151–2
fertility clinic, colloquial terms for

136

find, phrasal verbs for 175
fingers, idioms for 150–1
fit, phrasal verbs for 175
Five ‘C’s of good nursing practice 7
flesh, idioms for 151
fluid balance chart 39, 42
foot (feet), idioms for 151–2
forehead, idioms for 146
forms of address 52

general expressions 132–3
General NHS Hospital Trust 27
general practitioner (GP) 5, 26, 28,

31, 55, 59

General Test (IELTS) 18
get, phrasal verbs for 175–7
give, phrasal verbs for 177–8
go, phrasal verbs for 178–81
grades, nursing 32–3

hair, idioms for 152
hand, idioms for 152–4
head, idioms for 154–6

C3996_13.qxd 26/02/2004 13:59 Page 234

INDEX

235

health behaviour see lifestyle
health visitors (HV) 29
healthcare assistants (HCAs) 5
heart, idioms for 156–7
heel(s), idioms for 157–8
hobbies and interests 58
holistic care 1
home, type of 57–8
Hospital for Sick Children in

London 27

idioms – parts of the body 141–67
incident/accident form 44–5
informed consent 43–4
integrated care 1
International Council of Nurses

(ICN) 5

International English Language

Testing System (IELTS) 18–19,
21

job interview, preparing for 21–2
job vacancies 21

keep, phrasal verbs for 181–2
knee, idioms for 158
knuckles, idioms for 158

lap, idioms for 158
lecturer–practitioner 32, 33
leg, idioms for 158–9
leisure see working and playing
let, phrasal verbs for 182
letter writing 46–9

envelope 46–7
letter 47–9

lifestyle 59
lip, idioms for 159
look, phrasal verbs for 182–4

make, phrasal verbs for 184
medical history 56

medical names, colloquial terms

for 137–40

medicine/drug chart 43
men’s health expressions 134
mental states, colloquial terms for

129–31

mind, idioms for 159–60
mobility 72–3

case histories 73–8
words associated with 73

modern matron 32
mouth, idioms for 160

nail(s), idioms for 161
National Health Service (NHS) 5–7

structure 26–34

National Institute for Clinical

Excellence (NICE) 26

National Nursing Association

(NNA) 5

neck, idioms for 161–2
nerve(s), idioms for 162
neurological observation chart –

Glasgow Coma Scale (GCS) 39,
40–1

next of kin 53
NHS see National Health Service
NHS Direct 26
NHS Plan for England 10
NHS Trusts see Acute Care Trusts,

NHS

nose, idioms for 162–3
Notification of Practice form 19
nurse consultant 32
nurse education programmes 5, 15
nurse practitioners 28
Nurse Prescribers’ Formulary 28
Nurse Registration Act (1919) 13
Nursing and Midwifery Council

(NMC) 13, 14
Code of Professional Conduct

3–4

C3996_13.qxd 26/02/2004 13:59 Page 235

Professional Identification

Number (PIN) 16, 17

role of 2
website 21

nursing assessment 8
nursing assessment sheet 38
nursing care plan 8–9, 38–9, 51, 52
nursing degrees 22
nursing process 7–9
nursing programmes 14–19

occupational health nurses 6
occupational therapists (OTs) 28, 59
opticians 31
optometrists 31
outpatient departments 6

pain 117–21

case history 120–1
commonly used words 118–19
words associated with 117

palm, idioms for 163
periodic registration 2–4, 19–20
personal care 89

case histories 89–94
words associated with 90

phrasal verbs 169–91
physical function 57
physical states, colloquial terms for

129–31

physiotherapists 28, 34, 59
podiatrists 28, 59
postgraduate dental surgeons 31
post-registration education and

practice (PREP) 19–20

practice nurse 28, 55, 59
Primary Care Trusts (PCTs) 17, 27–9
Primary Healthcare Teams (PHCTs)

28–9

private sector 5–7
Professional Identification Number

(PIN) 16, 17

professional organisations 4–5

INDEX

236

professions allied to medicine 34
Project 2000 (PK2) 5
Psychiatric NHS Trust 27
put, phrasal verbs for 185–6

qualifications 22

for registration 16–17

reason for admission/treatment 55–7
record keeping 37–46
reflection 121
reflective diary 20
Registered Nurses 13, 16, 28, 32–3
registration

adaptation programmes (super-

vised practice) 17–18

communication in English

18–19

continuing professional devel-

opment (CPD) 4, 19–20

obtaining 14–19
periodic registration 19
qualifications 16–17
requirements 13

regulation in the UK 2–4
religion 53–4
reproductive health problems,

colloquial terms for 133–7

reviews 22
role of nurses, expanding 10–11
Royal College of Midwives (RCM) 5
Royal College of Nursing (RCN) 4, 5
run, phrasal verbs for 187–8

safety and accident prevention 68

case histories 68–72
words associated with 69

salary grade 22
secondary hospital care 30–4
self-care model 9
send, phrasal verbs for 188
set, phrasal verbs for 188
sexual health expressions 135–6

C3996_13.qxd 26/02/2004 13:59 Page 236

sexuality 103

case histories 103–8
words associated with 103

sexually transmitted (acquired)

infections, colloquial terms for
136–7

shoulder, idioms for 163
skin

care 92–4
idioms for 164

skull, idioms for 164
sleeping 94

case history 94–8
words associated with 95

SMART system 38, 39
social history 57–9
social problems due to present

condition/admission 58

Social Services 34
Special Trusts 27
speech and language therapists

(SLTs) 31

Standing Committee of Nurses in

Europe 5

stomach, idioms for 164
Strategic Health Authorities (SHAs)

stress 108

case histories 108–13
words associated with 108

support networks 57

INDEX

237

take, phrasal verbs for 188–90
task-based care 1
teeth, idioms for 166–7
throat, idioms for 165
thumb, idioms for 165
titles 52
toe(s), idioms for 165
tongue, idioms for 166
tooth, idioms for 166–7
trade unions 4–5
turn, phrasal verbs for 190–1

UK Central Council for Nursing,

Midwifery and Health Visiting
(UKCC) 13

Unison 4
units of measurement 223–9
useful addresses 211–21

vital signs chart 39

websites 211–221
web resources 215–16
women’s health expressions 133–4
work history 54–5
working and playing 98

case histories 98–103
words associated with 99

C3996_13.qxd 26/02/2004 13:59 Page 237

Document Outline

Contents
1. Nursing in the UK
2. Registering as a nurse in the UK and career development
3. The National Health Service and Social Services
4. Nursing documentation, record keeping and written communication
5. Communication in nursing
6. Colloquial English
7. Idioms: parts of the body
8. Phrasal verbs
9. Abbreviations used in nursing
10. Useful addresses and web sources
11. Units of measurement
General further reading suggestions
Index
- A
- B
- C
- D
- E
- F
- G
- H
- I
- J
- K
- L
- M
- N
- O
- P
- Q
- R
- S
- T
- U
- V
- W

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